Sex-Based Differences in Perceived Stress and Recovery from Acute Myocardial Infarction

Psychosocial factors affect cardiovascular outcomes. Younger age and being female are both associated with greater mental stress. To examine sex-based differences in stress, contributing factors to these differences, and effects of these differences on 1-month recovery from acute myocardial infarction (AMI), investigators assessed data from the prospective, observational Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. Participants were 18- to 55-year-olds from 103 hospitals in the U.S., 24 in Spain, and 3 in Australia. Both baseline and 1-month interviews were completed by 3275 patients; 30 died before the 1-month interview. The median age for both sexes was 48 years; 60% of men and 48% of women presented with ST-segment elevation MI.

At baseline, women had significantly higher scores than men on a 14-item perceived stress scale. Women were more likely to have comorbidities, poor physical and mental health status, intrafamily conflict, caregiving demands, and financial hardship. In the multivariable regression model, adjustment for sociodemographics, health, and psychosocial characteristics substantially (but not completely) accounted for differences in baseline stress. At 1 month after AMI, general and angina-specific health status improved. However, men and women had significant differences in recovery after adjustment for sociodemographic and clinical characteristics; differences were attenuated but remained significant after further adjustment for baseline psychological stress. Women had significantly worse recovery by nearly all outcome measures. Patients who reported moderate or high stress had significantly worse recovery than those with low stress. When present, the effect of baseline stress on recovery did not differ between men and women.