Objective: To review the recent (1995–2009) literature on psychosocial risk and protective factors for coronary heart disease (CHD) among women, including negative emotions, stress, social relationships, and positive psychological factors.
Methods: Articles for the review were identified using PubMed and bibliographies of relevant articles. Eligible studies included at least 100 women and either focused on a) exclusively female participants or b) both men and women, conducting either gender-stratified analyses or examining interactions with gender. Sixty-seven published reports were identified that examined prospective associations with incident or recurrent CHD.
Results: In general, evidence suggests that depression, anxiety disorders, anger suppression, and stress associated with relationships or family responsibilities are associated with elevated CHD risk among women, that supportive social relationships and positive psychological factors may be associated with reduced risk, and that general anxiety, hostility, and work-related stress are less consistently associated with CHD among women relative to men.
Conclusions: A growing literature supports the significance of psychosocial factors for the development of CHD among women. Consideration of both traditional psychosocial factors (e.g., depression) and factors that may be especially important for women (e.g., stress associated with responsibilities at home or multiple roles) may improve identification of women at elevated risk as well as the development of effective psychological interventions for women with or at risk for CHD.
CHD = coronary heart disease; CRP = C-reactive protein; HWS = Healthy Women Study; IMT = intima-media thickness; MI = myocardial infarction; NHS = Nurses' Health Study; WHI = Women's Health Initiative.
From the Departments of Psychiatry (C.A.L., R.C.T., K.A.M.), Epidemiology (R.C.T., K.A.M.), and Psychology (K.A.M.), University of Pittsburgh, Pittsburgh, Pennsylvania.
Address correspondence and reprint requests to Carissa A. Low, PhD, Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213. E-mail: firstname.lastname@example.org
Received for publication February 16, 2010; revision received July 14, 2010.
This research was supported, in part, by grants AG029216 (R.C.T.), HL007560 (K.A.M.), and MH018269 from the National Institutes of Health (P.P.).