Stress may contribute to progression of coronary heart disease (CHD) through inflammation, especially among women . Thus, we sought to examine whether increased inflammatory response to stress among patients with CHD is associated with a greater risk of cardiovascular events and whether this risk is higher in women . We examined inflammatory biomarkers known to increase with mental stress (speech task), including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and matrix metallopeptidase-9 (MMP-9) among 562 patients with stable CHD . Inflammatory response, the difference between post-stress and resting values, was examined as a predictor of major adverse cardiovascular events (MACE) using subdistribution hazards models for competing risks adjusting for demographics, cardiovascular risk factors, and medications . MACE was defined as a composite endpoint of cardiovascular death, myocardial infarction, unstable angina with revascularization, and heart failure . All biomarkers were standardized . The mean age was 63 years (range 34-79) and 24% were women . During a median follow-up of 3 years , 71 patients experienced MACE . Overall, there was no significant association between inflammatory response to stress and risk of MACE, but there were sex-based interactions for IL-6 (p = 0.001) and MCP-1 (p = 0.008). The risk of MACE increased 56% (HR : 1.56; 95% CI : 1.21 , 2.01; p = 0.001) and 30% (HR : 1.30; 95% 1.09 . 1.55; p = 0.004) for each standard deviation increase in IL-6 and MCP-1 response to mental stress for women, respectively, while there was no association among men . Increased inflammation in response to stress is associated with future adverse cardiovascular outcomes among women with CHD.