Women with heart disease are more prone to anxiety, but less studied than men

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Cardiovascular disease and anxiety frequently go together, especially in women, who are two or three times more likely to struggle with anxiety than men.

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But when researchers at the University of Ottawa Heart Institute went looking for scientific literature on how anxiety affects women with heart conditions, they found no studies that looked at outcomes in women only. In studies involving men and women, women were significantly underrepresented.

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Most research into the connections between mental health and cardiovascular disease risk, it turns out, has been done on men.

Even as institutions such as the Heart Institute — which is home to the Women’s Heart Health Centre — work to reduce the well documented gender gap in cardiac care and research, it is a sign that gaps remain.

A team led by Dr. Heather Tulloch, a rehabilitation psychologist who directs the Cardiovascular Health Psychology and Behavioural Medicine laboratory at the Heart Institute, recently published a commentary in the European Journal of Preventative Cardiology (EJPC) calling for more research on the issue, especially in women.

The commentary is related to the review conducted by Tulloch and colleagues of available literature on the effects of anxiety on cardiovascular disease prognosis among women with a heart condition.

Building a better understanding of the effects of anxiety on cardiovascular disease is important both because it is so common, especially in women, and because some research links it to worse outcomes in patients with cardiovascular disease.

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Studies of people who have experienced a heart attack have found that post-event anxiety was associated with a 71 per cent increased risk of a recurrent heart attack and a 23 per cent increased risk of cardiac mortality, according to the Heart Institute.

But more work needs to be done to better understand the impact on women, say the papers’ authors.

“The prevalence of anxiety in women is about two to three times higher than in men,” said Dr. Karen Bouchard, an associate scientist and director of the Cardiovascular Health Promotion, Education and Social Determinants Laboratory at the University of Ottawa Heart Institute, and an author of the paper published in the EJPC.

“But we have only started scratching the surface on understanding the effects of this anxiety. The samples sizes are too small and disproportionate to discern how anxiety affects women, versus men.”

Bouchard and Tulloch are part of a team recently funded by the Canadian Institutes of Health Research to do some of that research investigating the impact of anxiety on cardiovascular outcomes in women with cardiovascular disease.

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Bouchard said it surprised her to find so little research involving women with cardiovascular disease and anxiety and none focused solely on women, after strides have been made in recognizing that women are different than men when it comes to heart disease. But research has yet to catch up.

“Women tend to be less than 25 per cent of the samples across all of these studies. Unfortunately, women are typically underrepresented in all studies,” said Bouchard.

The dearth of female focused studies spurred the researchers to apply for funding to do their own.

More research has been done on the links between depression and cardiovascular disease, but anxiety is also an important factor, say researchers and clinicians from the Heart Institute.

As many as four out of 10 patients with coronary artery disease report symptoms of anxiety during hospitalization, according to the Heart Institute.

Tulloch, who was not available for an interview, said in a news release that feeling anxious after a cardiovascular disease diagnosis is a normal human response but it could indicate a more serious problem if it is difficult to control and is causing fatigue, difficulty concentrating, sleep disruption, irritability or other symptoms.

At the Heart Institute, which has a psychology team, psychological support and screening are built into the rehabilitation program.

Although more research needs to be done, there is a growing recognition that mental health intervention that reduces depression and anxiety can have a downstream impact on cardiac outcomes, said Dr. Chelsea Moran, a clinical psychologist at the Heart Institute.

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