Study adds to growing evidence that social and psychological factors uniquely affect women’s heart health, offering new insights into why heart disease presents and progresses differently in women.
Women who see themselves as having lower social status are more likely than other people to show early signs of heart stress linked to future disease risk, according to a new study led by researchers at McGill and Concordia universities.
“One in three women in North America die from heart disease. Yet, women are less likely to receive important cardiac interventions or therapies than men. This highlights the need to rethink how we assess cardiovascular risk in women,” said co-lead author Dr. Judy Luu, Assistant Professor in McGill’s Department of Medicine and a clinician-scientist at the Research Institute of the McGill University Health Centre.
Subjective social status – how people feel they rank compared to others in terms of their social standing – has previously been linked to physical and mental health, with lower social status associated with poorer health. The findings of this study are among the first to show measurable, sex-specific effects in the heart.
More than 400 adults between the ages of 35 and 83, all without diagnosed heart disease, took part in the study. Each completed a questionnaire ranking their social standing on a 10-rung ladder. Cardiac MRI scans then measured early signs of stress in the heart’s tissue.
Women who ranked their social status lower showed more signs of potential inflammation and early scarring in the heart, even when their income and education matched those who ranked their status higher. Men who ranked their social status lower than others with the same income and education did not show these warning signs.
Why might women be more affected?
There are two theories that may explain the findings, said co-lead author Jean-Philippe Gouin, Full Professor of Psychology at Concordia.
“First, subjective social status may better reflect women’s real-life experiences than objective data on their socioeconomic status,” he said. “For example, even with the same education as men, women often earn less or face additional social pressures. So, their self-perception may capture those realities more accurately.”
The second theory is about psychological impact, he said. Women may feel fewer opportunities for upward mobility, which can lead to more stress.
The researchers note that stress is one of the top five risk factors for heart disease in women under 65. Experiences such as trauma, discrimination, and caregiving demands may contribute to the subtle changes in heart tissue observed in this study – suggesting early signs of inflammation, even before disease is diagnosed.
The researchers plan to follow a larger group of participants over time to see whether these early markers predict heart disease.
“We hope our work helps shift the paradigm in cardiac care,” said Luu. “We want to make it normal to discuss mental wellness, social circumstances and stress in routine medical practice.”
About the study
“Sex Differences in the Association Between Subjective Social Status and Imaging Markers of Cardiac Inflammation and Fibrosis” by Yolanda Sánchez-Carro, Jean-Philippe Gouin and Judy Luu et al., was published in Biopsychosocial Science and Medicine.
This study was funded by the Courtois Cardiovascular Biorepository Program.