Sex Differences in Stress in Younger Acute MI Patients | Journal Scan

Study Questions:

Is younger age and female sex associated with higher levels of mental stress among patients under the age of 55 presenting with acute myocardial infarction (AMI)?


The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study was used for the present analysis. This was a prospective study of men and women, ages 18-55 years, admitted with AMI to 130 hospitals, mostly in the United States, but also in Spain and Australia. Enrollment occurred from August 2008 to January 2012. Participants’ self-perceived psychological stress was measured using the Perceived Stress Scale (PSS-14) at baseline. Measures assessed at 1 month included the Seattle Angina Questionnaire (SAQ) and the Short Form (SF)-12 (a general measure of health status). A measure of health-related quality of life, the EuroQol utility index, was also collected.


A total of 3,572 participants (2,397 women and 1,175 men) were included in the present analysis. Median age of participants was 48 years for both men and women; clinical severity at presentation was similar for men and women as well. Women had higher levels of perceived stress than men (27.0 vs. 23.4, p < 0.001). Women had more comorbidities such as diabetes, lung disease, chronic renal insufficiency, and cancers. Women also were more likely to have depression. Women reported higher levels of stressful events in the year prior to their AMI including intrafamily conflict, major personal injury or illness, and death or illness of a close family member. Women also reported more financial strain than men. In multivariate analysis adjusting for demographic and clinical factors, women were observed to have worse recovery at 1-month post-AMI including lower scores for the EuroQol utility index and the SAQ compared to the male participants.


The authors concluded that higher stress levels at baseline were observed more often among female AMI patients compared to male AMI patients, and were associated with worse recovery at 1 month post-AMI.


These data suggest that stress may play an important role in recovery after AMI, and may explain prior observations suggesting that younger female AMI patients have worse outcomes after AMI. Interventions to reduce stress should be evaluated to determine if such interventions would result in improved outcomes after AMI.

Clinical Topics: Acute Coronary Syndromes, Prevention, Stress

Keywords: Acute Coronary Syndrome, Myocardial Infarction, Comorbidity, Depression, Female, Health Status, Quality of Life, Secondary Prevention, Life Change Events, Stress, Psychological, Angina Pectoris, Recovery of Function

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