Low social status linked to women’s heart risk

Women who see themselves as having lower social status are more likely than other people to show early signs of heart stress in the heart’s tissue – a pattern not seen in men.

The findings point to sex-specific effects, with women who rated their social standing lower displaying more signs of inflammation and early scarring in heart tissue. This held true even when their income and education matched those who ranked themselves higher.

More than 400 adults aged 35 to 83 with no history of heart disease took part in the study. Each completed a questionnaire ranking their social standing on a 10-rung ladder, followed by a cardiac MRI scan to detect early signs of stress in the heart’s tissue.

Researchers from McGill and Concordia universities found that subjective social status – how people feel they compare with others – affected women’s hearts differently to men’s. The results add to growing evidence that social and psychological pressures may influence women’s heart health in distinct ways.

“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 clinician-scientist at the Research Institute of the McGill University Health Centre.

Men who ranked their status lower than peers with similar income and education did not show the same heart changes.

Two possible explanations were suggested by co-lead author Jean-Philippe Gouin, 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. “Women may feel fewer opportunities for upward mobility, which can lead to more stress,” said Gouin.

Stress is among 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 findings could help explain why heart disease presents and progresses differently in women, and why disparities in care persist between sexes.

Researchers now plan to follow a larger group of participants over time to see whether these early signs can predict the development of 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.