Women, Heart Attacks and Emotionality

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

A few years back, we lost two Hollywood legends—Debbie Reynolds and her beloved daughter, Carrie Fisher – within one day of each other. Carrie had experienced a massive heart attack while traveling and died a few days later. The very next day, a stroke claimed the life of her mother.

This tragic turn of events really brought to light two things that I’ve been discussing for many years: the rising incidence of women and heart attack, and the strong link between emotions and heart/arterial health.

Heart disease is no longer a man’s disease as it was when I started med school. Back in the 1970s, I mainly saw men in the hospital recovering from heart attacks. Rarely did I treat a woman with heart disease. But in the 1980s, I began to notice a trend of more women developing heart issues, and by the 1990s the ratio of men to women was closer to 50/50. Today, heart disease is the top killer of both men and women, claiming one in four women every year.

Women’s Unique Risk Factors

When it comes to women and heart attacks (and cardiovascular disease), we certainly can’t discount physical risk factors like smoking as well as obesity, diabetes, poor nutrition, and inactivity. With obesity at epidemic levels in this country, it makes sense to see an uptick in obesity-related problems such as heart disease.

But women have other unique factors that add to their risk, especially as they get older. Menopause is a big one. The hormone estrogen has a protective effect on the heart. Specifically, estrogen is associated with higher levels of high-density lipoprotein (HDL), the beneficial cholesterol that helps to keep heart disease at bay. When estrogen levels drop after menopause, women no longer have that natural buffer, so their cardiovascular disease and heart attack risk goes up.

By and large, though, one of the most overlooked factors when it comes to women and heart attack is emotional turmoil. The pressures women face these days are extraordinary. There are more women and mothers in the workplace than ever before, and oftentimes they’re expected to give 100 percent not only at work, but also at home. This usually means putting their emotional needs aside and plowing through the day to get as much done as possible. Eventually, this type of lifestyle starts to take its toll in the form of chronic stress, anxiety and depression, and high blood pressure -all significant heart risk factors.

Women tend to be the more sensitive, compassionate, empathetic, and nurturing sex. They’re much more influenced and grounded by their emotions than men. For that reason, emotional upheaval tends to have a much more far-reaching impact on a woman’s physical health than a man’s.

To that end, it did not take long at all for the public to surmise that the real cause of Debbie’s Reynold’s death was a broken heart. You know what? It could be true…

There’s a well-documented and increasingly recognized phenomenon known as “broken heart syndrome” (also called stress-induced cardiomyopathy in medical circles). It often strikes after times of extreme stress (such as the sudden loss of a loved one), when the rapid and intense release of stress hormones literally stuns the heart. It acts very much like a heart attack in that symptoms include chest pain, shortness of breath, abnormal EKGs and blood work, and even heart failure. However, rarely is there an artery blockage typically seen in true heart attacks. Even though many women survive these “heart attacks,” they remain at greater risk of future heart problems.

Broken Heart Syndrome, Stress and Heart Disease

Over the years, I’ve seen countless cases where intense and sudden fits of emotion contributed to short- and long-term heart problems. I believe so strongly in this connection that I wrote a book nearly 20 years ago titled Heartbreak and Heart Disease.

NYU researcher and cardiologist Dr. Harmony Reynolds has also been studying this phenomenon for several years. In a study published in 2012, she identified 6,230 cases of broken heart syndrome—of which 90 percent were postmenopausal women with an average age of 65. Other studies have also confirmed that older women are most susceptible, suggesting a strong potential link between the syndrome and menopausal status. In other words, the lack of heart-protective estrogen seems to increase women’s vulnerability.

Embrace Emotional Release

When it comes to women and heart attack prevention, making certain lifestyle changes is certainly important. Lose weight, eat healthier, exercise more, and consider the use of bioidentical estrogen therapy to boost levels of this hormone. All of these steps can go a long way to improving your physical health and reducing your risk.

But…and this is a big but…your heart will never be in the best possible shape if you don’t also support your emotional health.

Over the past few decades, women have started to take on more male-centric roles, and part of that has involved the stifling of feelings. It’s frowned upon to get emotional in the workplace. Women are encouraged, even bullied, to work long hours to climb the corporate ladder, even to the detriment of their home lives. In the process, they have forced themselves to become less emotional, less open, less sensitive, less aware.

I’m asking all women to please, stop! Stop swallowing up your anger, suppressing your tears, shutting off your emotions, ignoring your stress, covering up your heartache. It will all come out somehow, at some point, and if you don’t deal with it constructively it will manifest in the form of a heart attack.

How to Relax

In a 2016 study also conducted by Dr. Reynolds, she discovered that women with episodes of stress-induced cardiomyopathy “have excessive sympathetic responsiveness and reduced parasympathetic modulation of heart rate.” In other words, they have poor heart rate variability (HRV).

The sympathetic nervous system prepares the body for fight or flight in response to a stressful situation, while the parasympathetic system has the opposite effect, calming and relaxing the body. So in plain English, these women lacked the ability to calm themselves down.

This is where truly effective stress-reducing techniques can and should come into play: Grounding / Earthing, yoga, meditation, guided imagery, deep breathing and alternate nostril breathing, and laughter all improve parasympathetic functioning – and thus  HRV,  in turn helping to promote a sense of peace and calm.

For religious or spiritual folks, prayer can work wonders. Exercise is also a proven stress buster that has the added benefit of strengthening the heart muscle and protecting against cardiovascular disease.

In cases of depression, anxiety, or heartache, I cannot sing the praises of spiritual counseling or professional therapy enough. A seasoned mental health professional can provide you with effective tools to combat emotional distress in a productive, healthy way.

Of course, your diet can have a major impact on how you feel too. To keep stress from getting the better of you, I’d avoid sugary foods that can cause extreme swings in blood sugar and insulin levels, which can impact your brain chemistry. Try sticking to an anti-inflammatory diet, Mediterranean-type diet like my PAMM diet, and eat lots of fiber-filled fruits and vegetables, and a good amount of healthy fats like nuts and olive oil, as well as quality lean protein.

There is no simple one-size-fits-all solution. But the take-home message I want all women to hear is this: Get back to nurturing and appreciating your emotionality. Cry. Laugh. Scream. And allow yourself to be your true self. Your heart will thank you.


  1. Minhas AS, Hughey AB, Kolias TJ. Nationwide trends in reported incidence of takotsubo cardiomyopathy from 2006-2012. Am J Cardiol. 2015 Oct 1;116(7):1128-31.
  2. Deshmukh A, et al. Prevalence of takotsubo cardiomyopathy in the United States. Am Heart J. 2012 Jul;164(1):66-71.
  3. Norcliffe-Kauffman L, et al. Automonic findings in takotsubo cardiomyopathy. Am J Cardiol. 2016 Jan 15;117(2):206-13.

© Stephen Sinatra, MD. All rights reserved.

Most Popular