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Heart Health: The Factors That Put Women at Risk for Heart Disease

Earlier this week, Barbra Streisand wrote an important reminder of the specific vulnerabilities that bear on the hearts of women and why we need to study this more closely. And as if in answer to this, an important review is about to reach print [1]. This review looked asked the question: Why are women at risk for coronary heart disease? And the answers were very interesting. Depression, anxiety disorders, anger suppression and stress associated with relationships and family responsibilities contributed significantly to coronary heart disease in women but general anxiety, hostility and work-related stress had similar effects on men and women. Definitely disturbing, but what does this mean?

At the most basic level, why do the hearts of women strain when feelings get out of control? And what do these different factors have in common?

They are all about stuckness: People talk about depression as if it is about sadness when at a fundamental level, it is also as much about stuckness. Anxiety leads to "freezing" stuck responses too, and anger suppression is also about something not being able to make its way out. Even stress is about stuckness when it causes memory circuits to become activated so that only old habits of being are recreated. In a sense, these factors, when they strike, are like jamming the brakes. And the heart has to work that much harder to keep things moving and happening.

But these findings are also interesting because it is not general anxiety but anxiety disorders that pose a risk; it is not hostility but the suppression of anger that is also a risk; and not work-related stress but the stress of social relationships that pose the tremendous risk that burden a woman's heart. It appears that a certain threshold has to be crossed before the heart starts to strain. While anxiety and anger may both be signals of impending heart strain in women, they have to reach proportions of "disorder" or be so high as to need to be suppressed for the risk to reveal itself. The bad news is that this happens at all. The good news is that we an do something about this.

This study would seem to suggest that general anxiety itself does not confer specific risk to coronary heart disease in women, but it may signal the beginning of a disorder. This would suggest that rather than waiting for the anxiety to be out of control, it would probably in the best interest of women to decrease the anxiety at that stage rather than wait for the full-blown disorder to occur. The same for anger. Early constructive expression may prevent the need for suppression, and if expectations about relationships and family responsibilities are managed earlier on, there may be less of a need for the heart to "feel" as though it needs to work harder. The point here is that it seems that much of this is preventable, and that setting up systems to prevent progression of anxiety depression and anger may actually also prevent heart disease. In fact, the study supported this in part because the review also showed that supportive social relationships and positive psychological factors may be associated with reduced risk of coronary heart disease.

Thus, a review like this raises awareness that our brains and hearts are very connected and that our moods can be a real weight that prevents vital body organs from getting blood. And it also emphasizes that heart disease may be modifiable at a more basic level.

To start this journey toward modification of risk factors then, ask yourself first: Are you in the brake-jam phase of life where nothing seems to be moving fast enough? Because if you are, your heart is probably feeling this as well. The heart tells the stories of its well-being in the language of feelings. Listen to your heart when it tells you stories in the languages of depression and anxiety, for if you do, you may be able to change the language of its stories, and in so doing, have the very change of heart you desire -- at a very literal level.

Reference
1. Low, C.A., R.C. Thurston, and K.A. Matthews, Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med, 2010. 72(9): p. 842-54.