Younger women — ages 18 to 55 — represent only a fraction of the nation's 720,000 heart attacks each year. About 35,000. But they have a significantly more difficult recovery. The reason? Stress.

A Yale University study published this month in Circulation, a journal of the American Heart Association, found that young women heart attack survivors were in worse shape a month out than their male counterparts. They had more chest pain, less physical function and a lower quality of life.


And they were more likely to report a significantly higher level of mental stress.

According to the report, women heart attack sufferers were more likely to report family conflict, injury, illness or death of a close family member or a major injury or illness of their own. Men? Not so much. They most often reported work or financial stressors.

This is a fairly conventional stereotype. Women are inextricably tangled in the emotional lives of their families, and they can find it almost impossible to lay down these burdens. Men, while they worry about their jobs and the families' financial well-being, are less likely to be so deeply empathetic with family and friends.

But women are also more likely to be in the workforce than at any time in our history, and they are saddled with those stressors, too.

"Women, if you think about it, are being hit from a lot of different angles," said Dr. Michael Miller, professor of medicine at the University of Maryland School of Medicine and director of the Center for Preventive Cardiology.

"Women are more emotionally invested at home and at work, compared to men. They are expending more energy."

The role of stress in physical wellbeing is no longer some vague concept of worry and furrowed brow. Dr. Miller says science has shown that stress ages the cardiovascular system, and there are tools to measure just how much.

"You can actually look at the arterial stiffness and find it vastly different from the chronological age. A 45-year-old woman might have the arteries of a 65-year-old. These new tools can unmask the real risk you face," said Dr. Miller, author of "Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease."

Stress can contribute to blood pressure, heart rhythms and the build-up of plaque, and, because of their stress levels, this means women are more at risk for heart disease than men.


If you were going to write a prescription for women in the double bind of work and family, that would be it. Researchers like Dr. Miller have actually seen the physical changes in the heart and blood flow that come with laughter, music, meditation, exercise and just plain fun.

But there are other complicating factors in women's heart health. Heart attacks do not present with the same symptoms in men and women, and she might not realize what is happening. Instead of chest pain, she might feel pain in her back, nausea, lightheadedness or just extreme fatigue.

Women are also more likely to postpone seeking medical help until all the items on their to-do list have been scratched off. Considering all they are juggling, women are more likely to put themselves last. As a result of waiting longer to seek care, women are often in poorer health to begin with.

In addition, the kinds of heart-healthy lifestyle choices a woman should make may just look like too much to undertake. Quitting smoking, losing weight, healthy food preparation, exercise, time to relax. When is a working mother of school-aged children supposed to fit these things into her schedule?


A heart attack is a life-changing experience on its own. Compound the recovery with the effort to take care of family and return to work, and it is no wonder the path back to normal is so much longer for women.

And, considering their place as the linchpin in the life of the family, so much more important.

Susan Reimer's column appears on Mondays and Thursdays. She can be reached at sreimer@baltsun.com and @SusanReimer on Twitter.com.