A new study has found a variation among men and women regarding the impact of mental stress on the heart. The study examined men and women who were already receiving treatment for heart disease. Results from the study, published October 13 in the Journal of the American College of Cardiology, included 56 women and 254 men diagnosed with heart disease and were enrolled in a larger REMIT study regarding the impact of the medication escitalopram on mental stress-induced heart disease.

After taking part in baseline testing, study participants performed three mentally stressful tasks, including mental arithmetic, mirror tracing, and anger recall tests, followed by a treadmill exercise test. During the mental stress tasks and periods of rest between tests, researchers conducted echocardiography to study changes within the heart, took blood samples, and measured participants’ blood pressure and heart rate.

Researchers from the Duke Heart Center discovered that while men exhibited more changes in heart rate and blood pressure in response to the mental stress, more women experienced myocardial ischemia, or decreased blood flow to the heart, along with increased platelet aggregation, the beginning of blood clot formation, than men. When compared to men, women also showed a greater increase in negative emotions and a larger decrease in positive emotions during the mental stress tests.

The study’s lead author, Zainab Samad, MD, MHS, assistant professor of medicine at Duke University Medical Center, Durham, North Carolina, said in a statement, “The relationship between mental stress and cardiovascular disease is well known.” He continued, “This study revealed that mental stress affects the cardiovascular health of men and women differently. We need to recognize this difference when evaluating and treating patients for cardiovascular disease.”

According to the Centers for Disease Control and Prevention, approximately one in every four deaths, or 600,000 people annually, is due to heart disease.