CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

September 24th, 2012

Stress and Coronary Heart Disease: What Role Does Gender Play?

Dr. Xu is a health economist at Yale University School of Medicine. Her research has focused on improving health care delivery and health outcomes of older adults and women, as well as economic evaluation of health interventions.

I am glad to see a growing literature on the link between psychosocial stress and coronary heart disease, as well as an increased interest in the gender differences in this relationship.  But the assessment of psychosocial stress from a gender perspective seems to deserve more careful thinking and discussion.

A meta-analysis published in the Lancet last week reported a significant and “broadly similar” association between job strain and incidence of coronary heart disease for men and women.  Like many existing studies, this analysis measured job strain based on workload demand and control.  While these are two important work-related stressors, they may not adequately capture stress from work-family conflict often encountered by women because of the multiple roles they play in family life and at work.  For example, caregiving responsibilities for children and elderly parents often fall on the female members of the family.  This can cause major work-family conflict for women and become an important source of stress.

Men, on the other hand, appear to be more affected by job insecurity – another work-related stressor.  Just like Dr. Netterstrøm pointed out in the comment accompanying the Lancet article – that “different types of work will have different strain profiles” – there are unique strain profiles for men and women as well.  Whether evaluating data or consulting patients, let us all be a little more cautious about the role of gender when assessing stress as a risk factor for cardiovascular diseases.

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One Response to “Stress and Coronary Heart Disease: What Role Does Gender Play?”

  1. Charles Christiansen, PhD, MA, BS says:
    September 25, 2012 at 9:35 am

    This is a very important line of inquiry and one that should continue to be pursued vigorously to provide additional evidence for the role of stressors in CHD. I do believe that gender role responsibilities are changing, so investigators would be well advised not to make assumptions about how caregiving stressors distribute themselves across genders within families. In the end, one could argue that it is not the type of stressor but rather the individual’s emotional response to the stressor that determines the PNI impact of a given situation.