Skip to main content
Top
Published in: Current Cardiology Reports 6/2019

01-06-2019 | Myocardial Infarction | Psychological Aspects of Cardiovascular Diseases (A Steptoe, Section Editor)

Psychosocial Factors and Recovery After Acute Myocardial Infarction in Younger Women

Authors: Kim G. Smolderen, Anna Brush, Rachel P. Dreyer

Published in: Current Cardiology Reports | Issue 6/2019

Login to get access

Abstract

Purpose of Review

To explain sex and gender approaches to studying acute myocardial infarction (AMI) risk and outcomes in younger women (18–55 years). More specifically, by looking at the AMI care pathway—from AMI risk to receiving acute and follow-up outpatient care to longer term AMI outcomes—we will examine where potential psychosocial factors may be associated with inequalities in AMI care and outcomes in younger women.

Recent Findings

Despite recent declines in AMI incidence, morbidity, and mortality rates, younger women stand out as a group whose incidence has risen and who face worse outcomes following AMI, as compared with other groups. A focus on gender, rather than the binary, biological sex construct, allowed researchers to better understand potential pathways as to why younger women are facing this risk. Feminine traits and disproportionate exposures to psychosocial stressors in society at large may be correlated with inequalities in AMI care and further AMI outcomes in younger women. Psychosocial interventions in women with AMI that have proven to be successful have embraced this wider gender concept.

Summary

Adopting a wider gender-concept to understand roles and demands that are placed on individuals that make them more at risk to experience psychosocial stressors and make it more challenging to organize self-care, get access to care, and equitable care may be needed.
Literature
1.
go back to reference Wilmot KA, O'Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women. Circulation. 2015;132(11):997–1002.CrossRef Wilmot KA, O'Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women. Circulation. 2015;132(11):997–1002.CrossRef
2.
go back to reference Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337–45.CrossRef Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337–45.CrossRef
3.
go back to reference •• Dreyer RP, Sciria C, Spatz ES, Safdar B, D’Onofrio G, Krumholz HM. Young women with acute myocardial infarction: current perspectives. Circ Cardiovasc Qual Outcomes. 2017;10(2) This study provides a thorough overview of the epidemiology of acute myocardial infarction in younger women specifically, associated characteristics and quality of care and outcomes differences as a function of sex and gender. •• Dreyer RP, Sciria C, Spatz ES, Safdar B, D’Onofrio G, Krumholz HM. Young women with acute myocardial infarction: current perspectives. Circ Cardiovasc Qual Outcomes. 2017;10(2) This study provides a thorough overview of the epidemiology of acute myocardial infarction in younger women specifically, associated characteristics and quality of care and outcomes differences as a function of sex and gender.
4.
go back to reference Phillips SP. Defining and measuring gender: a social determinant of health whose time has come. Int J Equity Health. 2005;4:11.CrossRef Phillips SP. Defining and measuring gender: a social determinant of health whose time has come. Int J Equity Health. 2005;4:11.CrossRef
5.
6.
go back to reference •• Pelletier R, Ditto B, Pilote L. A composite measure of gender and its association with risk factors in patients with premature acute coronary syndrome. Psychosom Med. 2015;77(5):517–26 Describes the methodological development process of the gender index as used in the multicenter observational GENESIS-PRAXI study across the United States, Canada, and Switzerland. The instrument was used to study the association between gender, sex, and cardiovascular risk among younger patients who survived an acute myocardial infarction. CrossRef •• Pelletier R, Ditto B, Pilote L. A composite measure of gender and its association with risk factors in patients with premature acute coronary syndrome. Psychosom Med. 2015;77(5):517–26 Describes the methodological development process of the gender index as used in the multicenter observational GENESIS-PRAXI study across the United States, Canada, and Switzerland. The instrument was used to study the association between gender, sex, and cardiovascular risk among younger patients who survived an acute myocardial infarction. CrossRef
8.
go back to reference Johnson JL, Greaves L, Repta R. Better science with sex and gender: facilitating the use of a sex and gender-based analysis in health research. Int J Equity Health. 2009;8:14.CrossRef Johnson JL, Greaves L, Repta R. Better science with sex and gender: facilitating the use of a sex and gender-based analysis in health research. Int J Equity Health. 2009;8:14.CrossRef
9.
go back to reference Johnson JLGL, Repta R. Better science with sex and gender: a primer for health research. Vancouver: Women’s Health Research Network; 2007. Johnson JLGL, Repta R. Better science with sex and gender: a primer for health research. Vancouver: Women’s Health Research Network; 2007.
10.
go back to reference Choi J, Daskalopoulou SS, Thanassoulis G, Karp I, Pelletier R, Behlouli H, et al. Sex- and gender-related risk factor burden in patients with premature acute coronary syndrome. Can J Cardiol. 2014;30(1):109–17.CrossRef Choi J, Daskalopoulou SS, Thanassoulis G, Karp I, Pelletier R, Behlouli H, et al. Sex- and gender-related risk factor burden in patients with premature acute coronary syndrome. Can J Cardiol. 2014;30(1):109–17.CrossRef
11.
go back to reference •• Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, et al. Sex Versus Gender-Related Characteristics: Which Predicts Outcome After Acute Coronary Syndrome in the Young? J Am Coll Cardiol. 2016;67(2):127–35 In the multicenter, observational GENESIS-PRAXI study, a total of 273 women and 636 men age 18 to 55 years were studied after they had a heart attack. From information derived from the gender index, they observed that younger adults with feminine gender traits were at increased risk of experiencing another heart attack in the following year, regardless of female sex. CrossRef •• Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, et al. Sex Versus Gender-Related Characteristics: Which Predicts Outcome After Acute Coronary Syndrome in the Young? J Am Coll Cardiol. 2016;67(2):127–35 In the multicenter, observational GENESIS-PRAXI study, a total of 273 women and 636 men age 18 to 55 years were studied after they had a heart attack. From information derived from the gender index, they observed that younger adults with feminine gender traits were at increased risk of experiencing another heart attack in the following year, regardless of female sex. CrossRef
12.
go back to reference Radley A, Grove A, Wright S, Thurston H. Gender-role identity after heart attack: links with sex and subjective health status. Psychol Health. 2000;15:123–33.CrossRef Radley A, Grove A, Wright S, Thurston H. Gender-role identity after heart attack: links with sex and subjective health status. Psychol Health. 2000;15:123–33.CrossRef
13.
go back to reference Low CA, Thurston RC, Matthews KA. Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med. 2010;72(9):842–54.CrossRef Low CA, Thurston RC, Matthews KA. Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med. 2010;72(9):842–54.CrossRef
14.
go back to reference Sheps DS, Soufer R, Freedland KE. Psychological stress and myocardial ischemia: understanding the link and the implications. Psychosom Med. 2007;69(6):491–2.CrossRef Sheps DS, Soufer R, Freedland KE. Psychological stress and myocardial ischemia: understanding the link and the implications. Psychosom Med. 2007;69(6):491–2.CrossRef
15.
go back to reference Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):1237–46.CrossRef Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):1237–46.CrossRef
16.
go back to reference Kivimaki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J. Work stress in the etiology of coronary heart disease--a meta-analysis. Scand J Work Environ Health. 2006;32(6):431–42.CrossRef Kivimaki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J. Work stress in the etiology of coronary heart disease--a meta-analysis. Scand J Work Environ Health. 2006;32(6):431–42.CrossRef
17.
go back to reference Steptoe A, Kivimaki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9(6):360–70.CrossRef Steptoe A, Kivimaki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9(6):360–70.CrossRef
18.
go back to reference Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet (London, England). 2004;364(9438):937–52.CrossRef Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet (London, England). 2004;364(9438):937–52.CrossRef
19.
go back to reference Smolderen KG, Strait KM, Dreyer RP, D'Onofrio G, Zhou S, Lichtman JH, et al. Depressive symptoms in younger women and men with acute myocardial infarction: insights from the VIRGO study. J Am Heart Assoc. 2015;4(4). Smolderen KG, Strait KM, Dreyer RP, D'Onofrio G, Zhou S, Lichtman JH, et al. Depressive symptoms in younger women and men with acute myocardial infarction: insights from the VIRGO study. J Am Heart Assoc. 2015;4(4).
20.
go back to reference Mallik S, Spertus JA, Reid KJ, Krumholz HM, Rumsfeld JS, Weintraub WS, et al. Depressive symptoms after acute myocardial infarction: evidence for highest rates in younger women. Arch Intern Med. 2006;166(8):876–83.CrossRef Mallik S, Spertus JA, Reid KJ, Krumholz HM, Rumsfeld JS, Weintraub WS, et al. Depressive symptoms after acute myocardial infarction: evidence for highest rates in younger women. Arch Intern Med. 2006;166(8):876–83.CrossRef
21.
go back to reference Moller-Leimkuhler AM. Gender differences in cardiovascular disease and comorbid depression. Dialogues Clin Neurosci. 2007;9(1):71–83.PubMedPubMedCentral Moller-Leimkuhler AM. Gender differences in cardiovascular disease and comorbid depression. Dialogues Clin Neurosci. 2007;9(1):71–83.PubMedPubMedCentral
22.
go back to reference Bucholz EM, Strait KM, Dreyer RP, Lindau ST, D'Onofrio G, Geda M, et al. Editor's choice-Sex differences in young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardiovasc Care. 2017;6(7):610–22.CrossRef Bucholz EM, Strait KM, Dreyer RP, Lindau ST, D'Onofrio G, Geda M, et al. Editor's choice-Sex differences in young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardiovasc Care. 2017;6(7):610–22.CrossRef
23.
go back to reference D'Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al. Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: results from the VIRGO study. Circulation. 2015;131(15):1324–32.CrossRef D'Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al. Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: results from the VIRGO study. Circulation. 2015;131(15):1324–32.CrossRef
24.
go back to reference Pelletier R, Humphries KH, Shimony A, Bacon SL, Lavoie KL, Rabi D, et al. Sex-related differences in access to care among patients with premature acute coronary syndrome. CMAJ. 2014;186(7):497–504.CrossRef Pelletier R, Humphries KH, Shimony A, Bacon SL, Lavoie KL, Rabi D, et al. Sex-related differences in access to care among patients with premature acute coronary syndrome. CMAJ. 2014;186(7):497–504.CrossRef
25.
go back to reference Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRef Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRef
26.
go back to reference Smolderen KG, Spertus JA, Gosch K, Dreyer RP, D'Onofrio G, Lichtman JH, et al. Depression treatment and health status outcomes in young patients with acute myocardial infarction: insights from the VIRGO study (variation in recovery: role of gender on outcomes of young AMI patients). Circulation. 2017;135(18):1762–4.CrossRef Smolderen KG, Spertus JA, Gosch K, Dreyer RP, D'Onofrio G, Lichtman JH, et al. Depression treatment and health status outcomes in young patients with acute myocardial infarction: insights from the VIRGO study (variation in recovery: role of gender on outcomes of young AMI patients). Circulation. 2017;135(18):1762–4.CrossRef
27.
go back to reference Smolderen KG, Buchanan DM, Gosch K, Whooley M, Chan PS, Vaccarino V, et al. Depression treatment and 1-year mortality after acute myocardial infarction: insights from the TRIUMPH registry (translational Research investigating underlying disparities in acute myocardial infarction Patients' health status). Circulation. 2017;135(18):1681–9.CrossRef Smolderen KG, Buchanan DM, Gosch K, Whooley M, Chan PS, Vaccarino V, et al. Depression treatment and 1-year mortality after acute myocardial infarction: insights from the TRIUMPH registry (translational Research investigating underlying disparities in acute myocardial infarction Patients' health status). Circulation. 2017;135(18):1681–9.CrossRef
28.
go back to reference Beckman AL, Bucholz EM, Zhang W, Xu X, Dreyer RP, Strait KM, et al. Sex differences in financial barriers and the relationship to recovery after acute myocardial infarction. J Am Heart Assoc. 2016;5(10). Beckman AL, Bucholz EM, Zhang W, Xu X, Dreyer RP, Strait KM, et al. Sex differences in financial barriers and the relationship to recovery after acute myocardial infarction. J Am Heart Assoc. 2016;5(10).
29.
go back to reference Reese RL, Freedland KE, Steinmeyer BC, Rich MW, Rackley JW, Carney RM. Depression and rehospitalization following acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2011;4(6):626–33.CrossRef Reese RL, Freedland KE, Steinmeyer BC, Rich MW, Rackley JW, Carney RM. Depression and rehospitalization following acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2011;4(6):626–33.CrossRef
30.
go back to reference Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.CrossRef Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.CrossRef
31.
go back to reference Arnold SV, Smolderen KG, Buchanan DM, Li Y, Spertus JA. Perceived stress in myocardial infarction: long-term mortality and health status outcomes. J Am Coll Cardiol. 2012;60(18):1756–63.CrossRef Arnold SV, Smolderen KG, Buchanan DM, Li Y, Spertus JA. Perceived stress in myocardial infarction: long-term mortality and health status outcomes. J Am Coll Cardiol. 2012;60(18):1756–63.CrossRef
32.
go back to reference Pilote L, Karp I. GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-premature acute coronary SYndrome). Am Heart J. 2012;163(5):741–6.e2.CrossRef Pilote L, Karp I. GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-premature acute coronary SYndrome). Am Heart J. 2012;163(5):741–6.e2.CrossRef
33.
go back to reference Lichtman JH, Lorenze NP, D'Onofrio G, Spertus JA, Lindau ST, Morgan TM, et al. Variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study design. Circ Cardiovasc Qual Outcomes. 2010;3(6):684–93.CrossRef Lichtman JH, Lorenze NP, D'Onofrio G, Spertus JA, Lindau ST, Morgan TM, et al. Variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study design. Circ Cardiovasc Qual Outcomes. 2010;3(6):684–93.CrossRef
34.
go back to reference Dreyer RP, Wang Y, Strait KM, Lorenze NP, D'Onofrio G, Bueno H, et al. Gender differences in the trajectory of recovery in health status among young patients with acute myocardial infarction: results from the variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study. Circulation. 2015;131(22):1971–80.CrossRef Dreyer RP, Wang Y, Strait KM, Lorenze NP, D'Onofrio G, Bueno H, et al. Gender differences in the trajectory of recovery in health status among young patients with acute myocardial infarction: results from the variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study. Circulation. 2015;131(22):1971–80.CrossRef
35.
go back to reference Pelletier R, Choi J, Winters N, Eisenberg MJ, Bacon SL, Cox J, et al. Sex differences in clinical outcomes after premature acute coronary syndrome. Can J Cardiol. 2016;32(12):1447–53.CrossRef Pelletier R, Choi J, Winters N, Eisenberg MJ, Bacon SL, Cox J, et al. Sex differences in clinical outcomes after premature acute coronary syndrome. Can J Cardiol. 2016;32(12):1447–53.CrossRef
36.
go back to reference Dreyer RP, Dharmarajan K, Kennedy KF, Jones PG, Vaccarino V, Murugiah K, et al. Sex differences in 1-year all-cause rehospitalization in patients after acute myocardial infarction: a prospective observational study. Circulation. 2017;135(6):521–31.CrossRef Dreyer RP, Dharmarajan K, Kennedy KF, Jones PG, Vaccarino V, Murugiah K, et al. Sex differences in 1-year all-cause rehospitalization in patients after acute myocardial infarction: a prospective observational study. Circulation. 2017;135(6):521–31.CrossRef
37.
go back to reference Cossette S, Frasure-Smith N, Lesperance F. Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program. Psychosom Med. 2001;63(2):257–66.CrossRef Cossette S, Frasure-Smith N, Lesperance F. Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program. Psychosom Med. 2001;63(2):257–66.CrossRef
38.
go back to reference Orth-Gomer K, Schneiderman N, Wang HX, Walldin C, Blom M, Jernberg T. Stress reduction prolongs life in women with coronary disease: the Stockholm Women’s intervention trial for coronary heart disease (SWITCHD). Circ Cardiovasc Qual Outcomes. 2009;2(1):25–32.CrossRef Orth-Gomer K, Schneiderman N, Wang HX, Walldin C, Blom M, Jernberg T. Stress reduction prolongs life in women with coronary disease: the Stockholm Women’s intervention trial for coronary heart disease (SWITCHD). Circ Cardiovasc Qual Outcomes. 2009;2(1):25–32.CrossRef
39.
go back to reference Beckie TM, Fletcher G, Groer MW, Kip KE, Ji M. Biopsychosocial health disparities among young women enrolled in cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2015;35(2):103–13.CrossRef Beckie TM, Fletcher G, Groer MW, Kip KE, Ji M. Biopsychosocial health disparities among young women enrolled in cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2015;35(2):103–13.CrossRef
40.
go back to reference Menzin J, Wygant G, Hauch O, Jackel J, Friedman M. One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin. 2008;24(2):461–8.CrossRef Menzin J, Wygant G, Hauch O, Jackel J, Friedman M. One-year costs of ischemic heart disease among patients with acute coronary syndromes: findings from a multi-employer claims database. Curr Med Res Opin. 2008;24(2):461–8.CrossRef
41.
go back to reference Johnston SS, Curkendall S, Makenbaeva D, Mozaffari E, Goetzel R, Burton W, et al. The direct and indirect cost burden of acute coronary syndrome. J Occup Environ Med. 2011;53(1):2–7.CrossRef Johnston SS, Curkendall S, Makenbaeva D, Mozaffari E, Goetzel R, Burton W, et al. The direct and indirect cost burden of acute coronary syndrome. J Occup Environ Med. 2011;53(1):2–7.CrossRef
42.
go back to reference Kauf TL, Velazquez EJ, Crosslin DR, Weaver WD, Diaz R, Granger CB, et al. The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry. Am Heart J. 2006;151(1):206–12.CrossRef Kauf TL, Velazquez EJ, Crosslin DR, Weaver WD, Diaz R, Granger CB, et al. The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry. Am Heart J. 2006;151(1):206–12.CrossRef
43.
go back to reference Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–e209.CrossRef Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–e209.CrossRef
Metadata
Title
Psychosocial Factors and Recovery After Acute Myocardial Infarction in Younger Women
Authors
Kim G. Smolderen
Anna Brush
Rachel P. Dreyer
Publication date
01-06-2019
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 6/2019
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-019-1140-x

Other articles of this Issue 6/2019

Current Cardiology Reports 6/2019 Go to the issue

Ischemic Heart Disease (D Mukherjee, Section Editor)

Refractory Angina: the Current State of Mechanical Therapies

Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)

Polygenic Hypercholesterolemia and Cardiovascular Disease Risk

Ischemic Heart Disease (D Mukherjee, Section Editor)

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes

Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)

Is There a Need to Revise Goals in the Management of Dyslipidemias?

Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)

Treatment Challenges in Patients with Acute Heart Failure and Severe Aortic Valve Stenosis