Traumatic life events such as the death of a loved one or life-threatening illness increased the chances of a heart attack by more than 65 percent among middle-aged and older women regardless of heart disease risk factors or socioeconomic status, according to research that was published Wednesday on the American Heart Association journal website Circulation: Cardiovascular Quality & Outcomes.

The research was originally scheduled to be released as part of the Quality of Care and Outcomes Research 2015 Scientific Sessions, which was cancelled due to violent protests in the city of Baltimore.

Psychological stress is known to contribute to the risk of heart disease and heart attack, but in this study researchers looked at what types of stress had significant impact on heart health in middle-aged and older women by comparing Michelle Albert, MD MPHwomen who had suffered heart attacks to women who hadn’t. In addition to traumatic life events increasing risk, researchers also found that a history of financial struggle was independently associated with a two-fold higher risk for heart attack. Women living in households earning less than $50,000 per year, which is above the federal poverty threshold, appeared to be more vulnerable to heart attack.

“Much of the prior research related to negative life events was done in persons who have a history of heart attacks and in men,” said Michelle A. Albert, M.D., M.P.H., senior study author and director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DisEase, known as NURTURE Center, at the University of California Medical Center, San Francisco. “It is important to assess these relationships in middle-aged and older women as this age group is more susceptible to heart disease as they age and are likely to live longer with disability.”

The findings are based on 26,763 women, average age of 56, who participated in the national Women’s Health Study. Women were asked questions about negative life events such as being fired from a job, legal problems, unemployment, marital infidelity, financial strain, death of a loved one, and life-threatening injuries or illness to themselves or a loved one and then followed up for an average of nine years. The researchers compared 267 women who had a history of heart attack and 281 women of similar age who smoked.

“We don’t know whether women are more physiologically vulnerable as some prior research suggests that decreases in blood flow to the heart caused by acute mentally-induced stress is more common in women and individuals with less social support,” Albert said. “At the biological level, we know that adverse experiences including psychological ones can lead to increased inflammation and cortisol levels. However, the interplay between gender, heart disease and psychological factors is poorly understood.”