Why Mental Stress Affects Heart Health in Women More Often

What happens in the body when broken heart syndrome strikes? Why do women’s hearts react more to mental stress?

Puja K. Mehta, MD, FACC, FAHA, is an associate professor in the Division of Cardiology at Emory University and the director of Women’s Translational Cardiovascular Research. She is a member of the Emory Women’s Heart Center, which focuses on providing cardiovascular screenings to and optimizing cardiac care for women.

Dr. Mehta searches for answers to these questions in her research, which focuses on women and cardiovascular health. She’s conducted several studies funded by the National Institutes of Health.

She’s exploring how:

• Cardiac nerves and cardiac blood vessels work together
• Mental stress changes blood flow to the heart
• Mental stress causes chest pain
• Microvascular disease impacts the heart’s reaction to stress

Dr. Mehta uses mental stress tests in a lab. Study participants are asked to recall a situation that made them angry or to complete math problems under pressure. Their blood pressure and heart rate are monitored.

Results show that women with microvascular conditions feel more chest pain that lasts longer after the stress tests than women without the condition.

Dr. Mehta is launching a new study to pinpoint what’s happening with stress and the heart as women age. Women will undergo mental stress tests in a lab and then monitor their heart function at home. Test groups will include women with microvascular disease, women with coronary artery conditions and healthy women with no chest pain.

“We’ll try to figure out whether what happens at home and how the heart reacts triggers some of this,” Dr. Mehta says.

Cardiac imaging will add additional detail. The images check the heart’s sympathetic or nerve function during stress. The findings could lead to ideas for potential treatments.

Mining the Brain-Heart Connection

Knowing that women react more strongly to psychological and psychosocial stress than men provides a guide for finding better interventions and treatments.

Dr. Mehta says doctors treat patients by traditionally focusing on coronary artery blockages. While they screen for depression and anxiety, they don’t often pay attention to marital, socioeconomic and work stress.

“We are not formally assessing trauma, and it’s something we might miss,” Dr. Mehta says.

Instead, heart doctors could work with psychiatrists and mental health professionals.

“We see patients at one point in their life and come up with a medical plan for them, but if they also saw a psychologist or psychiatrist, we might uncover a lot more about depression, anxiety and ongoing stressors,” she says.

Research advancements let scientists and doctors see the impacts of stress on the brain-heart connection.

Dr. Mehta is applying for a grant to study brain changes caused by stress. She will compare brain imaging after mental stress in patients with microvascular chest pain to brain images of patients without microvascular disease.

“We want to see what happens in the brain because that is where the chest pain is perceived,” she says.

Doctors can now marry brain and heart imaging with stress-related changes in blood biomarkers and metabolism rates and cardiac function. This puts science on the cusp of gaining new insights into how stress causes our hearts and minds to react.

All the clinical data can be married with back-to-basics practices of relaxation as doctors learn more about how relaxation changes inflammation and metabolism.

“That is the next frontier,” Dr. Mehta says. “That is what we are looking forward to.”