Heart disease is the number one cause of death
in women worldwide.
disorders are more commonly observed in women than in men.
- Women suffering from an
anxiety disorder may have less blood pumping to their hearts while exercising.
disease symptoms in women may be atypical, unlike in men.
- Heart disease detection
in women must be based on objective tests as symptoms of anxiety may mask the
symptoms of an underlying heart disease, making the diagnosis difficult to
symptoms of anxiety and mood disorders, like palpitations (sensation of having a rapid heartbeat), flushing and discomfort in
the chest, may conceal the symptoms of heart disease in
and thus delay diagnosis and treatment. A study recently conducted at
University of Quebec, Canada supports the theory.
Overview of the Study
The study was conducted by Kim Lavoie, a
professor of Psychology at the University of Quebec at Montreal and her team.
2300 subjects were included in the study, out of which 760 were women. SPECT (Single Photon Emission Computed
Tomography) exercise stress test
was conducted and
followed by a psychiatric interview (The Primary Care Evaluation of Mental Disorders). The aim of the study was to examine the
effects of gender and mood disorders on the risk of myocardial ischemia
(reduction of blood supply to the heart). The study and its results were
published in the journal- Circulation: Cardiovascular Quality and Outcomes.
‘Objective tests are important to diagnose heart disease in women which may otherwise be misdiagnosed as anxiety.’
Risk Factors for Heart Disease in Women
The study has revealed that anxiety may not just
have emotional manifestations. It may have physical ramifications in women as
- Psychiatric diseases and
mood disorders like panic disorders
and/or anxiety, may increase the risk of ischemia in women. Anxiety in itself, can cause spasms of the coronary arteries and
reduce perfusion of the heart without the presence of a coronary artery
blockage. It can also cause chronic
which may lead to constantly elevated levels of cortisol in the body, which can
be a risk factor
for the development of heart disease. Stress also leads to behavioral changes, e.g.
smoking, which are not conducive to good cardiac health.
- Men experience the
classic symptoms of chest pain and shortness of breath in coronary artery blockage while women experience
atypical ones like palpitations,
hot flushes, chest discomfort and neck pain. These are very similar to
the signs of anxiety and the diagnosis of a coronary artery disease may be
missed or delayed. Stress is also associated with an abnormal autonomic
control. This may be the reason why women with coronary artery disease show
worse outcomes than their male counterparts.
- Another study conducted
by Deepak L.Bhatt,
MD, MPH, FACC, across 366 U.S. hospitals and over 49000 patients revealed that
women were less likely to receive appropriate care as compared to men and therefore, showed a
higher mortality rate owing to sub-optimal care. This revelation, coupled with
the theory that heart disease is often misdiagnosed in
women as anxiety, can have serious consequences.
The study has sent across an important message- stress and anxiety may deteriorate the health of a woman's
- Anxiety and psychiatric disorders must
be taken seriously and treated early with cognitive therapies and medication.
- Physicians need to test
women extensively before attributing the cause to a psychogenic source instead
of coronary artery blockage.
- Women with anxiety disorders must be
tested for heart disease as anxiety predisposes such patients to myocardial
- Awareness among women must be raised over stress management
and the adoption of a healthy
and active lifestyle to ensure good cardiac health.
'The idea that stress can be related to ischemia
and even a heart attack is an important message to get across,'' said Dr.
Carolyn Lam Su Ping, senior consultant at the National Heart Centre in Singapore.
Physicians over the world have been researching
long over the association of stress and anxiety with heart disease. This study
has proven once again that the concern possibly holds true. Anxiety has a detrimental effect on
pre-existing heart conditions and even delays diagnosis and treatment.
Physicians have divided opinions on this issue,
but quite a few believe that there may exist a diagnostic bias due to the similarity of symptoms
of anxiety and heart disease that may cause labeling of women with coronary
artery disease as those suffering from a mood disorder. This study supports the
fact that physicians need to assess patients both physically as well as
mentally as anxiety is a common ailment of the modern world. Not treating
anxiety may have equally disastrous
effects as misdiagnosing
an underlying heart condition as anxiety.
Further research needs to be undertaken in order
to ascertain the extent to which anxiety and mood disorders affect the outcomes
in patients with coronary artery disease and whether early intervention and
treatment of psychiatric ailments can result in improved outcomes in these
Laura D. Kubzansky,
Ichiro Kawachi, Scott T. Weiss, David Sparrow; ''Anxiety and Coronary Heart
Disease: A synthesis of epidemiological, psychological, and experimental
evidence'', Annals of Behavioural Medicine, June 1998, Volume 20, Issue 2