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Introduction

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The social and psychological risks for CHD:

  • behaviour patterns of individuals (eg. type A personality)

  • hostility

  • social support

  • hopelessness

  • depression

  • social class

  • education

 are well studied, though more frequently in men than in women.

 What do we know about  how recovery from coronary heart disease and myocardial infarction are affected by psychosocial factors in men and women?

Type A Personality

Type A behaviour[1], a risk factor for CHD among men has been described as "An action emotion complex which is exhibited by those individuals who are engaged in a relatively chronic struggle to obtain an unlimited number of poorly defined things from their environment in the shortest period of time, and if necessary, against the opposing efforts of other things or persons in the same environment." Since this definition was based on the behaviour of middle class white men, the effect of type A personality on CHD and women, has been questioned. Although more research needs to be done to account for impact of Type A on women’s cardiovascular health, currently it is believed that Type A personality in women is a possible predictor of angina but not CAD[2].

Hostility

Hostility as a psychosocial contributing factor in developing CHD has been well researched[3]. The link between chronic hostility and CAD in men has also been suggested in women, although, there are only a few studies that have included women[4]. Hostile behaviour has not yet been identified as a strong predictor of CHD among women compared to men, future research may find potential differences between the sexes in this domain.

Social Support

Another psychosocial factor impacting women’s cardiovascular health is social support. While some reports show that women with social support seem to have reduced CHD mortality rates, other studies show no difference in developing CHD in women. However, researchers have found an improvement in survival of female patients with social support recovering from MI[5].

Socioeconomic Status and Education

There is a strong evidence that socioeconomic status (SES) is related to CHD risk and that lower SES and lower educational levels are risk factors for women[6]. However, research shows that women married to men in manual occupations (considered to be lower SES) are more likely to die from CHD. Lower education has been associated with higher risk of developing conditions such as higher systolic blood pressure, triglycerides, glucose, and body mass index in women. Reports also show that women with lower education are more likely to smoke, drink and have lower level of physical exercise[5].

 

 

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1. Rosenman R.H., Brand, R.J., Jenkins C.D., (1975) Coronary Heart Disease is the Western Collaborative Group Study: Final Follow-up Experience of 8 1/2 Years. JAMA, 233: 872-877.

2. Charney, P., Coronary Artery Disease in Women: What all Physicians Need to Know. Philadelphia: American College of Physicians; 1999.

3. Friedman, H.S. (1982) Hostility, Coping, and Health. Washington DC: American Psychological Association.

4. Marcuccio, E., Loving, N., Bennett, S.K., Hayes, S.N., (2003) A Survey of Attitudes and Experiences of Women with Heart Disease. Women’s Health Issues, 13: 23-31.

5. Eaker, E.D., (1998) Psychosocial Risk Factors For Coronary Heart Disease in Women. Cardiology Clinics, 16(1): 103-111.

6. Brezinka, V., Kittel, F., (1996) Psychosocial Factors of Coronary Heart Disease in Women: a Review. Soc Sci Med. 42: 1351-65.

All references for this section