Young women report more stress than men soon after a heart attack, which may explain their worse recovery, according to a new study. 

“It has been known for a while that (the) mortality rate is higher in younger women than in younger men after heart attack,” said lead author Xiao Xu, assistant professor of obstetrics, gynecology and reproductive sciences at Yale University in New Haven, Connecticut.

But few studies have looked at gender differences in other outcomes, Xu told Reuters Health by email.

“Women tend to experience greater stress than men, even in the general population regardless of heart attack status,” she said. “Our study confirmed such a gender difference in young and middle-aged patients with heart attack.”

The researchers compared 2,397 women and 1,175 men under age 55 who were hospitalized in the U.S., Spain or Australia with a heart attack. The severity of the heart attacks was similar for women and men.

While hospitalized, participants answered 14 questions about their recent stress levels. One month later, researchers re-interviewed them and assessed their recovery.

At the first interview, those who were younger and female tended to have higher stress scores than those who were older or male, the authors reported in a paper scheduled for publication in the journal Circulation. On the 0- to 56-point stress scale, men averaged 23.4 points and women averaged 27 points.

A third of women had experienced major family conflict within the past year compared to 20 percent of men. More women than men also reported a major personal injury, illness or death of a family member over the past year.

Women tend to have lower financial resources than men and are often faced with more demands for family care, which may explain their higher stress, Xu said.

Women in the study also had more diabetes, lung disease, kidney problems, depression, cancer and previous heart problems.

At the one-month point, women had worse chest-pain related physical function, quality of life and overall health.

“We had known that women have worse health status after a heart attack for some time,” said Dr. Suzanne V. Arnold, a research assistant professor at the University of Missouri in Kansas City. “What we don't really understand is why.”

Arnold, who was not involved in the new study, noted that people who have more issues with their health and personal lives also experience more stress, and in this study, the women tended to have more of both.

Stress is associated with heart attack and even death, Arnold said.

“However, stress is associated with so many other things – including smoking, lack of exercise, comorbidities, etc. – that are also strong risk factors for heart attack,” so stress was probably not the main cause of most of the heart attacks, she said.

After a heart attack, patients are often advised to adopt healthy lifestyles and receive therapies such as beta-blockers, but people under more stress may be less likely to comply, Xu said.

Stressed people are more likely to engage in smoking and drinking behaviors or have disruptions in their treatment regimen, she said.

“When caring for younger patients with heart attack, especially younger women patients, we should look beyond their physical health and pay attention to their psychosocial status as well,” Xu said.

“Although our study demonstrated a strong relationship between higher mental stress and worse recovery, we cannot make causal inferences,” she said. “We still need more research to understand the exact mechanisms through which mental stress operates to affect recovery.”

All heart attack patients, regardless of gender, should be screened for chronic stress, Arnold said.

“I think this research highlights again the importance of recognizing and addressing the level of perceived stress of heart attack patients,” she said. “I don't think men or women should be treated differently, as any ‘intervention’ for stress would need to be customized for the individual patient and his or her psychosocial needs.”