Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women

•Compared with men, women have a higher prevalence of psychosocial factors that have been linked to cardiovascular disease.•Exposure to stress early in life is linked to enduring neurobiological changes in adulthood.•Young women could be especially vulnerable to the adverse effects of stress on the heart compared with men and older women.•Stress-related vascular physiology could help explain unique features of heart disease in women.

Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.