Women with heart disease are more prone to mental stress-induced ischemia than men, potentially raising the risk of adverse cardiovascular events and death, according to a new study in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association journal.

The researchers arrived at this conclusion by studying 678 adults (average age 63) with coronary artery disease as they delivered a speech. Both before and during the public speaking stressor, the researchers used myocardial perfusion imaging to observe heart function and peripheral arterial tonometry to detect differences in blood vessel constriction.

“This research is important because previous studies have shown that a reduction in blood supply to the heart (ischemia) during mental stress doubles the risk of heart attack or death from heart disease,” senior study author Viola Vaccarino, MD, PhD, professor of epidemiology and medicine at Emory University in Atlanta, said in a press release. “This increased risk of adverse cardiovascular events is about the same level as that seen in people who develop reduced blood flow in the heart muscle during a conventional test, such as a treadmill stress test.”

Vaccarino and colleagues noted men and women responded differently to stress. In women, the peripheral blood vessels constricted during episodes of mental stress, which could force the heart to work harder to pump blood. If blood supply to the heart was reduced in men during stressful situations, it was mostly due to a rise in blood pressure and heart rate, the authors wrote.

“Our findings in the peripheral circulation also could reflect what occurs in the arteries in the heart,” Vaccarino said. “Instead of dilating and increasing blood flow to the heart during stress, in women the tiny blood vessels are constricted, leading to areas of reduced blood flow. Constriction of peripheral vessels can also induce ischemia in the heart indirectly, because the heart has to pump against increased resistance.”

The researchers said their findings highlight the need for people with heart disease to find ways to reduce their psychological stress levels, such as relaxation techniques or exercise. Also, health professionals should consider the effects of mental stress on their patients and refer them to other specialists if they need help with depression or anxiety, Vaccarino said.

Although the study highlights a potential cause for increased stress-related cardiovascular events, it is unknown whether the study participants eventually had a higher incidence of heart attacks and other indicators of worsening heart disease. The researchers aim to answer that question with future research.