Introduction:
Cardiovascular Diseases are the leading cause of death globally, with symptoms presenting differently among men and women. Historically, research has disregarded the notable impact of CVD on women as studies have focused more on men. This gap in research has led to a miscommunication among populations about the manifestations and risk factors associated with CVD in women. Among these risk factors, stress is a significant concern as it can exaggerate pre-existing conditions and contribute to the development of new health issues. Stress, regardless of its origin (psychosocial, career linked, life events, etc), has been associated with adverse cardiovascular events and outcomes. This article will explore the literature on the cardiovascular risks associated with stress in women. Through examining physiological mechanisms, the goal is to present information supporting the differential impact of CVD on women, and the need for implications regarding prevention and treatment.
Literature Review:
A distressed state of an individual, whether environmental or psychological, activates a cascade of stress hormones impacting the physiological state. The sympathetic nervous system is activated in this manner, triggering various physiological responses. This event leads to an increased release of stress hormones like adrenaline and cortisol. In addition to this, the body reacts with changes in vital functioning, like increased heart rate and blood pressure, redistribution of blood flow, and organ functions. Chronic activation of this response can threaten cardiovascular health through effects of long term strain (Keteepe-Arachi, 2017). Research has shown that chronic stress can lead to endothelial dysfunction, arterial stiffness, and increased inflammatory responses (Toda, 2011). These conditions are all critical factors associated with the development of severe cardiovascular diseases. Specifically, endothelial dysfunction being one of the earliest presentations of atherosclerosis (Henein, 2022). Impaired function in the endothelium can significantly affect perfusion and blood flow (Henein, 2022). This physiological result of chronic stress is cause for concern.
While stress is a common reaction to life events and changes, it should be noted that men and women experience different signs and symptoms related to stress. Stress in women strays from the “fight or flight” model common in men. Female stress response is characterized by a ‘tend-and befriend’ model, geared towards seeking social support and the engagement of nurturing behaviors (Verma, 2011). This reaction activates the cortico-limbic areas of the brain associated with emotion regulation and sympathetic response. Research shows that this pattern could be responsible for the gender differences in neurohormonal and cardiovascular reactions to stress (Verma, 2011). Higher marked endothelial distress and intense vasoconstrictive sympathetic responses in women result in a higher female population with microvascular dysfunction (Henein, 2022). This variance in physiological responses impacts the gender respective indications and presence of cardiovascular risk factors.
It should also be noted that women experience higher levels of mental disorders, such as anxiety, depression, and PTSD (James, 2023). Research indicates that these stress related disorders are more prevalent in women and significantly elevate their risk of developing coronary heart disease. Psychosocial stressors, like work-induced stress, caregiving tasks, socio-economic burdens, and relationship factors, disproportionately affect women (Verma, 2011). Increased presence of these psychosocial factors have been linked to increased cardiovascular risk in women.
Discussion
Analyzing the interplay between psychosocial stressors and physiological functioning allow for a better understanding of the stress related cardiovascular risks in women. The peer reviewed articles studied, including research articles and literature reviews, provide insight to the depth and complexity of these factors. Mediated by physiological, psychosocial, social, and behavioral factors, women’s cardiovascular health is significantly different than that of men’s.
Physiologically, women have a stronger presence of stress-induced cardiovascular responses, especially when looking at the differences in autonomic and hormonal fluctuations. This includes the physiological changes during stages of menstruation, pregnancy, and menopause. From a psychological perspective, women experience higher rates of stress-related disorders that contribute to an elevated risk of cardiovascular disease.
These findings highlight the need for more gender-specific approaches to understanding and managing the cardiovascular health risks associated with stress. Current research presents stress-reduction intervention consisting of lifestyle modification, diet changes, and cognitive-behavioral therapy. While these may be effective forms of stress-reducing, more research is necessary to provide specific context for the physiological adaptations and improvements in women. With deeper consideration of age, hormonal stages, sympathetic responses, psychosocial state, genetic factors, etc, interventions would be much more effective in preventing and treating women’s cardiovascular health.
Conclusion
Stress is a prominent factor associated with cardiovascular risk, especially in women. With a complex relationship among physiological, psychological, and social factors, levels of stress in females remain a significant concern. Despite the growing evidence highlighting these risks, there remains a need for gender specific research in order to fully understand, prevent and treat cardiovascular disease in women. A comprehensive approach is required to address the cardiovascular risks associated with stress in females. The aspects of psychosocial factors and unique physiological responses of stress in women should be considered during future research and treatment approaches. By focusing more intensively on female specific cardiovascular health, there is potential for reducing the overall burden of cardiovascular disease.
References:
Henein, M. Y., Vancheri, S., Longo, G., & Vancheri, F. (2022). The Impact of Mental Stress on Cardiovascular Health-Part II. Journal of clinical medicine, 11(15), 4405. https://doi.org/10.3390/jcm11154405
James, K. A., Stromin, J. I., Steenkamp, N., & Combrinck, M. I. (2023). Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Frontiers in endocrinology, 14, 1085950. https://doi.org/10.3389/fendo.2023.1085950
Keteepe-Arachi, T., & Sharma, S. (2017). Cardiovascular Disease in Women: Understanding Symptoms and Risk Factors. European cardiology, 12(1), 10–13. https://doi.org/10.15420/ecr.2016:32:1
Toda, N., & Nakanishi-Toda, M. (2011). How mental stress affects endothelial function. Pflugers Archiv : European journal of physiology, 462(6), 779–794. https://doi.org/10.1007/s00424-011-1022-6
Verma, R., Balhara, Y. P., & Gupta, C. S. (2011). Gender differences in stress response: Role of developmental and biological determinants. Industrial psychiatry journal, 20(1), 4–10. https://doi.org/10.4103/0972-6748.98407