Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women

Abstract

Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.

Keywords: Stress; cardiovascular disease; gender factors; mental health; women.

Fig. 1

Neurobiology of stress and cardiovascular function. Brain regions involved in stress and depression (amygdala, hippocampus, medial prefrontal cortex, posterior cingulate, anterior cingulate) have outputs directly (medial prefrontal cortex) or indirectly through the hypothalamus and the medial prefrontal cortex to neurohormonal systems (cortisol, norepinephrine) affected by stress and depression. These pathways mediate increased heart rate and blood pressure, decreased heart rate variability, changes in platelet aggregation and endothelial function, conferring risk of coronary heart disease. BP: blood pressure; HR: heart rate; HRV: heart rate variability; CRF: corticotropin releasing factor; ACTH: adrenocorticotropic hormone; NE: noradrenaline.

Fig. 2

Diagram summarizing mechanisms linking behavioral and emotional factors to coronary heart disease in women. Neurobiological pathways affected by stressful exposures and stress-related mental disorders have downstream vascular, immune, metabolic and reproductive effects that, in turn, affect cardiovascular risk pathways. There is also the influence of health behaviors and the cumulative effects of acute stressful exposures resulting in repeated physiological and emotional reactivity. Genetic/epigenetic factors and individual resilience factors modulate these responses. HPA: Hypothalamic-Pituitary-Adrenal; SNS: Sympathetic Nervous System; PNS: Parasympathetic Nervous System.