Psychosocial risk in women with heart disease

Psychosocial risk factors such as chronic stress, depression, anxiety, post-traumatic stress, anger, hostility, and distressed personality increase the risk of acute and chronic ischemic heart diseases (obstructive and non-obstructive), heart failure (HF), and atrial fibrillation (AF). In general, women (with or without heart disease) are particularly vulnerable to the sequelae of stress and show higher prevalence of psychological risk factors compared to men. Important sex differences exist in the physiological stress response and its socio-cultural moderation. These notable differences have enticed the hypothesis that psychological stress may influence cardiovascular health differently in women versus men and therefore also lead to dissimilar cardiovascular risk and illness profiles. It is therefore crucial to take these differences into account in cardiologic clinical practice. The implementation of a comprehensive psychosocial screening instrument and the development of a more women-focused cardiac rehabilitation program, sensitive to women-specific stress-inducing barriers and treatment preferences, are important first steps to address the higher risk and prevalence of psychosocial risk factors in women.