The sex-dependent response to psychosocial stress and ischaemic heart disease

An example of a potential predictive model for psychological distress among nursing staff members

BackgroundNursing is considered a hard job and the stressors associated with this work can have negative effects on life satisfaction, quality of life and mental health.ObjectivesThe study aimed to develop a potential predictive model to identify the main factors influencing nurses' mental health, focusing on personal characteristics, working conditions, quality of life, and life satisfaction.MethodsThis cross-sectional study was focused on a sample of nurses at university hospital center in Sfax-Tunisia. Validated self-reporting instruments were used: Satisfaction With Life Scale (SWLS), World Health Organization Quality Of Life - BREF (WHOQOL-BREF) and General Health Questionnaire (GHQ 28). Statistical software R was used to perform the statistical analyses.ResultsThe survey included 199 nurses. The average GHQ-28 score was 27.3 ± 12.4. The predictive model identified the following significant predictors of psychological distress: female gender (β = 0.54, p < 0.001), presence of a chronic disease (β = 0.56, p < 0.001), bad financial status (β = 0.54, p < 0.001), and life satisfaction score (β = -0.6, p < 0.001), collectively explaining 40% of the variance in the total GHQ 28 score.ConclusionThese findings indicate that interventions promoting the mental health of nurses could be implemented by improving modifiable predictors such as physical health and life satisfaction.

Exploring the Science of Shape: How Physical Activity, Sleep, and Stress Affect Body Composition

In the contemporary context of health challenges, the focus on physical health has become a social and individual priority. Within this framework, body composition emerges as one of the key determinants of physical health, with deviations from normal body composition being associated with numerous pathological conditions that can lead to serious health issues. Consequently, there is an urgent need to synthesize the available knowledge and increase awareness regarding healthy body composition and the factors that shape its components. This narrative review aims to summarize the knowledge regarding the main components of body composition and the key factors that influence their development. The fundamental morphological characteristics and functions of the primary components of body composition-including adipose tissue, muscle mass, and bone tissue-are addressed. Furthermore, the available methods for assessing body composition are outlined. The role of three key factors that influence body composition is outlined, including, but not limited to, physical activity, sleep quality, and stress levels. Additionally, hormonal fluctuations that determine body composition in relation to the variability of these factors are discussed. The review provides evidence-based information that will be valuable both for disease prevention related to non-communicable diseases and for the promotion of health strategies aimed at long-term physical well-being.

Analysis of stress responses in medical students during simulated pericardiocentesis training using virtual reality and 3D-printed mannequin

We investigated the effectiveness of Virtual Reality (VR) and three-dimensional (3D)-printed mannequins in replicating stress levels during pericardiocentesis training and compared their impact on learners' emotional and physiological responses. A secondary analysis explored how demographic, lifestyle, and academic factors influence stress responses, providing deeper insights into the variability of physiological markers among medical trainees. We conducted a randomized study involving 108 final-year medical students (mean age: 23.6 years, 87% female) to compare stress responses during pericardiocentesis training using a 3D-printed mannequin and VR model as simulation modalities, both custom-designed by the research team. We investigated the influence of demographic, lifestyle, and academic factors, including medication use and perceived stress, on heart rate variability (HRV) markers. The two simulations showed similar HRV parameters, validating their effectiveness in replicating physiological stress levels associated with clinical scenarios. Secondary analysis revealed significant associations between the low frequency/high frequency ratio and family income and a trend-level effect for anxiolytic use, suggesting an interplay of socioeconomic and pharmacological factors on stress responses. Age and sex interacted significantly with HRV metrics, with younger students demonstrating heightened sympathetic activation. Our results suggest that the incorporation of VR into medical training programs may enhance learning outcomes and accessibility.

Toxic stress is associated with cardiovascular disease among younger but not older women in the United States: Results from the research goes red registry

Introduction

Psychosocial stress may be an under-recognized risk factor for cardiovascular disease among younger women (ages 35-54 years).

Methods

Data was obtained from the Research Goes Red Registry, initiated in 2019, and included women from the United States. Women self-reported diagnoses of cardiovascular disease and experiences of toxic stress defined as a significant life-defining stressful activity over a prolonged period unaccompanied by sufficient social resources. Logistic regression models were used to estimate odds ratios between toxic stress and cardiovascular disease and differences by age (< 55 versus ≥ 55 years of age) using an interaction term.

Results

The analytic dataset included 1346 women. The mean age of women was 47.8 (SD: 12.6), 71 % were less than 55 years of age, 83 % were Non-Hispanic White, 59 % indicated that they had experienced toxic stress, and 12 % had cardiovascular disease. In final multivariable models, there were significant differences in the association between toxic stress and cardiovascular disease by age group (toxic stress-by-age interaction = 0.0412) such that toxic stress was only significantly associated with an increased odds of cardiovascular disease among women < 55 years of age (OR: 1.79; 95 % CI: 1.03, 3.11) but not older women ≥ 55 years of age (OR: 0.82; 95 % CI: 0.49, 1.39).

Conclusion

Toxic stress was associated with an increased odds of cardiovascular disease among younger, but not older women in this cross-sectional study. Stress may be an under-recognized risk factor for cardiovascular disease, especially among younger women who may benefit from interventions to mitigate and prevent stress.

Allostatic Load in Parents and Offspring: Sex Differences and Intergenerational Effects on Cardiovascular Disease-Free Survival

BACKGROUND

Allostatic load (AL), a measure of cumulative stress-related physiological dysregulation, predicts the onset of chronic diseases. We investigated the relationship between AL and cardiovascular disease (CVD)-free survival in parents and offspring, including sex-specific differences.

METHODS

The analysis consisted of 6145 offspring-mother-father trios derived from the Framingham Heart Study. Clinically defined cutoffs from 9 physiological biomarkers across biological systems were used to generate composite AL score. Assessments of the associations of AL with CVD-free survival were conducted using Kaplan-Meier plots, Irwin's restricted means, and Cox proportional hazards regression models.

RESULTS

Over a 47-year period, parents and offspring experienced 1832 and 1060 incident CVD events, respectively. Parents exhibited a notably higher prevalence of high AL (29.5%) and CVD incidence rate (17.2 per 1000 person-years) compared with offspring (13.2% and 8.9, respectively, both P < .001). High parental AL was associated with 30% higher incident CVD risk in offspring, with maternal AL biomarkers being more predictive of offspring CVD risk than paternal. Parents and offspring with low AL lived 12.5 and 13.4 years longer without CVD, respectively, compared with those with high AL. The hazards of incident CVD were highest in daughters with high AL, up to 2.8 times (hazard ratio, 2.83; 95% confidence interval, 1.71-4.67), with similar risk observed in sons and parents.

CONCLUSION

Parental AL is associated with offspring CVD risk, with maternal AL biomarkers having a stronger association. This highlights the critical role of parental and, more importantly, maternal health in CVD risk management and broader public health strategies.

Sex-specific behavioral, cardiac, and neuroendocrine responses to repeated witness social stress in adult rats

In humans, sex disparities exist in the prevalence of social stress-related disorders, yet our understanding of the predisposing factors and underlying mechanisms is still elusive. Also at the preclinical level, the investigation of sex differences in social stress responses is limited. In this study, adult male and female wild-type Groningen rats were repeatedly exposed to witness social defeat stress (WS) to assess sex-specific behavioral, neuroendocrine, and cardiac responses to the same social stress paradigm. Male and female rats bore witness to an aggressive social defeat episode between two males for nine consecutive days or were exposed to a control (CTR) procedure. Stress-related parameters were assessed in correspondence to the first and last WS/CTR exposure and also during subsequent exposure to the stress context alone in the absence of social defeat. During WS, rats of both sexes displayed larger amounts of burying behavior and smaller amounts of rearing and grooming behaviors, but with a greater extent in female witnesses. Cardiac autonomic responses to WS were similar between the sexes, yet only females displayed higher plasma corticosterone levels after the first WS exposure compared to CTRs, and had a larger corticosterone increase than male witnesses upon repeated WS. Exposure to the stress context alone (i.e., without the presence of the aggressive resident rat) elicited greater amount of burying behavior and more pronounced and persistent tachycardic responses in females than males with a history of WS. Our findings suggest sex-disparities in the response of adult rats to WS at multiple behavioral, cardiac, and neuroendocrine levels, highlighting the utility of this social stress paradigm for investigating predisposing factors and pathophysiological mechanisms underlying sex-specific vulnerabilities to stress-related pathologies.

The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review

Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

BACKGROUND

We examined the risk of psychosocial distress, including Type D personality, depressive symptoms, anxiety, positive mood, hostility, and health status fatigue and disease specific and generic quality of life for MACE in patients with non-obstructive coronary artery disease (NOCAD).

METHODS

In the Tweesteden mild stenosis (TWIST) study, 546 patients with NOCAD were followed for 10 years to examine the occurrence of cardiac mortality, a major cardiac event, or non-cardiac mortality in the absence of a cardiac event. Cox proportional hazard models were used to examine the impact of psychosocial distress and health status on the occurrence of MACE while adjusting for age, sex, disease severity, and lifestyle covariates.

RESULTS

In total 19% of the patients (mean age baseline = 61, SD 9 years; 52% women) experienced MACE, with a lower risk for women compared to men. Positive mood (HR 0.97, 95%CI 0.95-1.00), fatigue (HR 1.03, 95%CI 1.00-1.06), and physical limitation (HR 0.99, 95%CI 0.98-1.00) were associated with MACE in adjusted models. No significant interactions between sex and psychosocial factors were present. Depressive symptoms were predictive of MACE, but no longer after adjustment.

CONCLUSIONS

In patients with NOCAD fatigue, low positive mood, and a lower physical limitation score were associated with MACE, without marked sex differences. Type D personality, psychosocial factors, and health status were not predictive of adverse outcomes. Reducing psychosocial distress is a valid intervention goal by itself, though it is less likely to affect MACE in patients with NOCAD.

Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan

PURPOSE OF REVIEW

Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women.

RECENT FINDINGS

For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.

The impact of 17β-estradiol on the estrogen-deficient female brain: from mechanisms to therapy with hot flushes as target symptoms

Sex steroids are essential for whole body development and functions. Among these steroids, 17β-estradiol (E2) has been known as the principal "female" hormone. However, E2's actions are not restricted to reproduction, as it plays a myriad of important roles throughout the body including the brain. In fact, this hormone also has profound effects on the female brain throughout the life span. The brain receives this gonadal hormone from the circulation, and local formation of E2 from testosterone via aromatase has been shown. Therefore, the brain appears to be not only a target but also a producer of this steroid. The beneficial broad actions of the hormone in the brain are the end result of well-orchestrated delayed genomic and rapid non-genomic responses. A drastic and steady decline in circulating E2 in a female occurs naturally over an extended period of time starting with the perimenopausal transition, as ovarian functions are gradually declining until the complete cessation of the menstrual cycle. The waning of endogenous E2 in the blood leads to an estrogen-deficient brain. This adversely impacts neural and behavioral functions and may lead to a constellation of maladies such as vasomotor symptoms with varying severity among women and, also, over time within an individual. Vasomotor symptoms triggered apparently by estrogen deficiency are related to abnormal changes in the hypothalamus particularly involving its preoptic and anterior areas. However, conventional hormone therapies to "re-estrogenize" the brain carry risks due to multiple confounding factors including unwanted hormonal exposure of the periphery. In this review, we focus on hot flushes as the archetypic manifestation of estrogen deprivation in the brain. Beyond our current mechanistic understanding of the symptoms, we highlight the arduous process and various obstacles of developing effective and safe therapies for hot flushes using E2. We discuss our preclinical efforts to constrain E2's beneficial actions to the brain by the DHED prodrug our laboratory developed to treat maladies associated with the hypoestrogenic brain.

Causes of stress and its impact on women's mental and physical health

OBJECTIVE

Aim: The aim is to investigate the causes of stress and its impact on women's mental and physical health indicators.

PATIENTS AND METHODS

Materials and Methods: The research was conducted from 2022 to 2024 and involved 157 women from Zhytomyr oblast (Ukraine) of different ages, education, professions, and geographic residence. The research methods included analysis of literary sources, medical and sociological (survey), statistical method.

RESULTS

Results: It has been established that during the war, the vast majority of women surveyed experienced very high and high levels of stress (45.2 % and 35.0 %, respectively). The main causes of stress for women include: "full-scale war" - 41.2 %, "financial difficulties" - 12.4 %, and "job loss" - 11.9 %. At the same time, only a fifth of the respondents (21.7 %) said they were able to overcome stress and neutralize the state of anxiety. It was found that stress in women led to insomnia (31.8 %), gastrointestinal disorders (40.1 %), exacerbation of chronic diseases (20.6 %), decreased immunity (8.4 %), and menstrual irregularities (7.2 %).

CONCLUSION

Conclusions: It has been found that the war had a significant impact on women's mental and physical health: the frequency of anxiety and depression, psychosomatic disorders, uncontrollable fear, and the desire to withdraw from people increased. Given this, public health professionals need to intensify awareness-raising activities in this area.

Advanced Cardiac Imaging and Women's Chest Pain: A Question of Gender

Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.