Stress and depression are known to increase the risk of heart attack, especially among women. They’ve also been linked to worse recovery. But does stress and depression contribute more to women with heart attacks with open arteries or blocked arteries? That’s what a new study published in the Journal of the American College of Cardiology aimed to find out.

Researchers found stress and depression were indeed common among women at the time of heart attack and for two months after. But they also found that women with heart attacks due to blockages in their coronary arteries had higher stress levels than those with heart attack with open arteries.

First author Anaïs Hausvater, MD, a cardiologist at the Sarah Ross Soter Center for Women’s Cardiovascular Research at the NYU Grossman School of Medicine in New York, says the study highlights the need for greater focus on mental health among women with heart disease.

“We have identified a subset of high-risk patients who fail to improve [their stress] or get worse after their event,” she says in a release. “It is important that clinicians, including cardiologists, screen their patients with heart disease for symptoms of stress, anxiety, and depression.”

For the multicenter study, 486 female patients completed questionnaires measuring their perceived stress and depression symptoms at the time of their heart attack and again two months later. Researchers then compared the results over time and looked at differences between the two types of heart attacks.

While both groups had signs of stress and depression, women with heart attack and open arteries were less likely to report high levels of stress, both at the time of heart attack and after.

Hausvater said because little is known about what causes heart attack with open arteries, these patients are often left with few answers about why it happened to them and how they can prevent it from happening again.

“We have observed clinically that this can cause distress among our patients,” she says in the release. “Prior studies have suggested that stress might contribute more to their disease, but we found this might not be true.”

One possible explanation is that younger patients might have different sources of stress, she adds. Older women, who are more likely to have blocked arteries, may be coping with more financial stressors, as well as the illness or loss of aging partners.

Future studies from the group will focus on sex differences in psychosocial factors among men and women with heart attacks. Researchers are also working on a study that looks at stress interventions for women after heart attack.

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