Gender differences in psychological risk factors for development of heart disease Geir Arild Espnes 1, * ,† and Don Byrne 2 1 Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway 2 School of Psychology, Australian National University, Canberra, Australia * Correspondence to: Prof. Geir Arild Espnes, Depart- ment of Social Work and Health Science, Norwegian University of Science and Technology, 7491 Trond- heim, Norway † E-mail: geirae@svt.ntnu.no Summary While coronary heart disease (CHD) for decades was understood as mainly a male disease group, it has through the last years become increasingly evident that it is now an important disease causing premature death also in the female populations throughout the Westernized world. The present paper scrutinizes via literature searches and discussions of relevant data the sex and gender differences in psychological risk factors for CHD with an emphasis on female risk. It is concluded that the risk factor picture in females is, due to limited research, still far from clear, even if there are indications of sex differences in both the risk factors picture and the trajectories of the disease development. Copyright © 2008 John Wiley & Sons, Ltd. Key Words Coronary heart disease, CHD, cardiovascular disease, CVD, gender, women. simply been assumed to parallel that of men (Asia Pacific Cohort Studies Collaboration, 2005). The obvious exception is the belief that higher estro- gen levels in women, relative to men, give a pro- tective effect against CHD development; this has been shown not to be the case (Barrett-Connor, 1997) It has also been expected that hormone replacement therapy (HRT) with estrogens could have positive effects, but research in recent years have concluded that women should not use estro- gen replacement with an expectation of cardio- vascular benefit (Herrington et al., 2000), and it has been pointed out that HRT in some cases in fact can increase the risk of cardiovascular events (Grady, 2003; Mosca et al., 2004). In the 1990s, however, it became increasingly evident that there had been a change in the pro- portion of CHD incidents between males and females in Western societies. This is partly due to Introduction Myocardial infarction (MI), angina and coronary artery atherosclerosis, collectively known as coro- nary heart disease (CHD) or cardiovascular disease (CVD), has for many decades, based on epidemiological data, mainly been considered and constructed as a male disease (Lockyer & Bury, 2002; Riska, 2002). This has to a great extent obscured the picture regarding sex differences in disease development (e.g. Hirsch & Meagher, 1984), and the risk factor profile in women has Stress and Health Stress and Health 24: 188–195 (2008) Published online 11 July 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/smi.1196 Received 05 November 2007; Accepted 17 January 2008 Copyright © 2008 John Wiley & Sons, Ltd.