"Women who develop heart disease at a younger age make up a special high risk group because they are disproportionately vulnerable to emotional stress," said study author Viola Vaccarino from the Emory University in the US.

Young and middle aged women may be more vulnerable to emotional stress because they face considerable burden of stressors in everyday life such as managing kids, marriage, jobs and caring for parents, Vaccarino said.

Biology may also play a role - for example, a greater propensity towards abnormal blood vessel function during emotional stress, such as exaggerated constriction of coronary or peripheral blood vessels.

Women generally develop heart disease later in life than men. However, young women who have premature heart attacks are more likely to die than men of similar age.

Risk factors, such as diabetes or high blood pressure, do not explain these mortality differences.

In the study, researchers gave a standardised mental stress test and, on a separate day, a traditional physical stress test to 534 patients with stable coronary heart disease.

Compared with men of the same age women aged 55 and younger had three times greater reduction in blood flow to the heart.

The study was presented at the ongoing American Heart Association's Scientific Sessions 2014 in Chicago, Illinois.

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