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Women who 'self-silence' in relationships may have more heart disease risk

The chronic stress of ignoring personal needs to put everyone else first could have physical consequences,study says.
/ Source: TODAY

Women who consider their romantic partners their best friends and talk about everything with them might truly be living their best lives. When women withhold their feelings, put their needs second and don’t talk to their romantic partners, a new study suggests they could actually be at greater risk for heart disease.

The findings are another example of recent research that shows the link between emotional wellbeing and overall health.

“There’s a growing literature of how social connections are relevant for health,” Karen Jakubowski, a postdoctoral fellow in the department of psychiatry at the University of Pittsburgh and an investigator of the research that will be presented this week at North American Menopause Society in Chicago, told TODAY.

“We wanted to go a step further in that direction,” she added, “What is the quality of the communication that we have with our social connections?”

The researchers looked at information from 304 pre- and post-menopausal women who were part of a study about hot flashes. They women filled out numerous questionnaires, including one that measured the idea of self-silencing — when people don’t communicate their feelings to steer away from a fight or save a relationship.

“Are you putting your partner’s needs before your own? Are you agreeing with them to avoid conflict?” Jakubowski said. “It could be the case that women are maybe not expressing their feelings and needs in relationships and they could relate that to their own health.”

The study also looked at physical health with some tests and measurements, including blood tests, body mass index calculations and ultrasounds of their carotid arteries, which can show plaques that develop before symptoms of heart disease begin.

The researchers found that women who said they self-silenced had more plaque in their carotid arteries than those who did not. While the study indicates a relationship between the two, the researchers cannot say that self-silencing is what caused the plaques to form.

“We adjusted in our analysis for a whole host of different things that are thought to be related to cardiovascular disease,” Jakubowski explained. “Self-silencing is related to plaque development over and above other variables.”

The findings reinforce what many experts have suspected about how relationships can influence overall health, according to Dr. Thomas Boyden, a cardiologist at Spectrum Health in Grand Rapids, Michigan, who was not involved with the study.

“The behaviors around self-silencing definitely impact health — depression, anger,” he told TODAY. “I can certainly see it leading to unhealthy lifestyles.”

Too much stress causes chronic inflammation, which can then lead to cardiovascular disease, according to Liisa Hantsoo, an assistant professor at the Penn Center for Women’s Behavioral Wellness, who was not involved with the study. She investigates the biology of women’s stress in her research and said self-silencing can cause a lot of extra strain in women’s lives.

“Over time these (self-silencing) behaviors can contribute to feeling stressed,” Hantsoo told TODAY. “Not expressing your needs can be really harmful.”

Boyden said he hears about how his female patients, friends and family members often put their needs after others', which could mean they’re ignoring their own health — and possibly not telling anyone when they experience symptoms of their own.

“Women have adverse outcomes from cardiovascular disease for many reasons,” he said. “Maybe they are not reporting certain things. They have a higher rate of death after heart attack than men. Maybe they take longer to get help.”

Hantsoo said there are steps that women can take to become more confident expressing themselves, such as speaking up in low-stakes situations like ordering at a coffee shop or asking for what they would like with friends.

“Start out small: ‘Can I have an extra sugar in that coffee?’ or ‘Let’s go to this art exhibit instead,’” she said. “As you start to practice that you will feel more comfortable practicing in higher stakes situations.”

Once they are comfortable with asking for what they want in these situations, women could feel more empowered to open up to their romantic partners or confide in their doctors about symptoms.

"You'll feel more comfortable putting your needs out there," Hanstsoo said.