Coronary heart disease (CHD) remains the leading cause of death in women in the United States and other industrial countries. CHD accounts for 250,000 female deaths per year, and in contrast to men, there is no indication of declining death rates. Women <65 years of age are twice as likely to die from myocardial infarction (MI) as men and have a poorer prognosis if they survive. Nevertheless, CHD has long been considered a “male” disease and many of the guidelines for prevention, diagnosis, and treatment of CHD are extrapolated from data of predominantly middle-aged men to women. It was only in the early 1990s that the National Institute of Health required that researchers report outcome analyses separately by sex. Since then, data has emerged showing that the magnitude of risk conferred by traditional risk factors for CHD (eg, hypertension, diabetes, and smoking) differs between men and women. Sex differences in molecular and cellular mechanisms, and genetics as well as responses to treatment are still vastly understudied.

Increasing evidence suggests that besides traditional CHD risk factors, negative emotions are independent prognostic risk factors for CHD. Recently published guidelines by an expert panel for cardiovascular disease prevention in women mention depression as a target for potential psychosocial interventions. Anxiety has also been shown to predict CHD incidence, acute coronary syndromes (ACS), morbidity and mortality post-ACS, and sudden cardiac death. Studies on the relationship between anxiety and CHD have shown mixed results.