Sex Differences in the Relationship Between Psychosocial Stress and Myocardial Tissue Characteristics: A CMR Imaging Study

BACKGROUND: Psychosocial stress is linked to the development of cardiovascular disease, with a more pronounced impact in female participants. This study investigates sex differences in the association between perceived stress and myocardial tissue characteristics, as assessed by cardiovascular magnetic resonance imaging, and evaluates the contribution of psychosocial burden, including caregiving and perceived social standing. METHODS: This study included 219 participants (53.9% females; mean age, 54.4±11.0 years) without overt cardiovascular disease, drawn from a prospective repository. Participants completed the perceived stress scale and cardiovascular magnetic resonance with native T1 and T2 mappings. Psychosocial variables included family caregiving responsibilities and perceived emotional support. The study investigated associations between perceived stress scale scores, and native T1 and T2 mapping sequences and assessed sex differences and psychosocial burden. RESULTS: High-stress female participants had significantly longer T1 times than low-stress female participants in both healthy and at-risk groups and longer T2 times in the at-risk group. No significant differences were observed in male participants. Perceived stress scale scores significantly predicted T1 values in female participants (95% CI, 0.088–3.517; P =0.040) but not in male participants (94% CI, −0.687 to 2.139; P =0.310). In multivariable analysis, caregiving burden and perceived emotional support were independent predictors of T1 in female participants ( P =0.009 and P =0.035, respectively) but not in male participants. CONCLUSIONS: Psychosocial stress was associated with early subclinical myocardial changes in female participants but not in male participants, suggesting sex-specific pathways linking stress to early myocardial remodeling. These findings support the integration of psychosocial factors into cardiovascular risk assessment for female individuals.