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Which women are more likely to die from recurrent heart attack?

STANFORD -- While in most men, Type A behavior patterns - such as angering quickly and chronically rushing for trivial reasons - increase the risk of recurrent heart attacks, in women the absence of these behaviors appears to increase that risk, researchers report.

In a study published in the September-October issue of Psychosomatic Medicine, the researchers reported that divorced women and women working full time without college degrees are more likely than others to die from a recurrent heart attack.

The study was led by Professor Carl Thoresen in the School of Education, who collaborated with associate professor of preventive medicine Lynda Powell at Rush Medical College in Chicago, and researchers at Yale School of Medicine and Kaiser Permanente Medical Center.

"The study makes clear that we really have to look with new eyes at the psychosocial predictors of heart attacks. What works in men doesn't always work in women," said Powell, who studied under Thoresen and received her doctorate at Stanford in 1982.

The results also led the researchers to speculate that the methods used to categorize people as "Type A" should be altered for women, as they appear to react to internal struggles differently than do men.

The authors followed 83 females between the ages of 30 and 63 who were participants in an ongoing treatment program designed to prevent a recurrent heart attack by changing lifestyle factors. All women were at least six months beyond their first heart attack when they enrolled. They were treated for four and a half years and followed for an additional four years. The researchers examined potential life stressors such as divorce, multiple roles (such as mother, wife, employee) and type of work, as well as how women responded to these stressors including anger, hostility and overall emotional arousability.

The researchers found that single, divorced, full-time working mothers had a risk of death 3.4 times higher than the other women in the study. They also postulate that older divorced women without college degrees who are working may experience particularly intense and prolonged psychosocial stresses.

"These women had been living the American dream, supporting their husbands. When the dream fell apart, they had to fend for themselves, usually by taking low status jobs.

"They're OK until they have heart attacks or some other crisis. Then they don't have enough money to buy their drugs or go to rehabilitation. Their economic deprivation puts them at a greater risk of death," Powell said.

A relative lack of Type A characteristics also significantly increased the risk of death, but to a lesser degree than did the condition of being a single, divorced, full-time working mother.

Why did women who were less likely to exhibit Type A behaviors run higher risks of heart attacks? The authors speculate that a relative absence of Type A behaviors in women could indicate suppressed negative emotions, such as unmet expectations, anger, resentment, loneliness and dissatisfaction. These bottled emotions may be a lethal combination for women with coronary heart disease, they write.

"This study has showed us that gender-sensitive measures of chronic negative emotions and behaviors in women must be developed - ones that are ethnically and culturally appropriate.

"Clearly we need much more research to provide the knowledge base upon which to help women prevent as well as deal with coronary heart disease, which still remains the number one overall cause of mortality in women," Thoresen said.


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