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A path model of chronic stress, the metabolic syndrome, and coronary heart disease

Peter P Vitaliano1, James M Scanlan, Jianping Zhang

  • 1Departments of Psychiatry and Behavioral Sciences and Medicine, University of Washington, Seattle, Washington 98195-6560, USA. pvital@u.washington.edu

Psychosomatic Medicine
|May 22, 2002
PubMed

Insights

Chronic stress increases coronary heart disease (CHD) risk in older men via distress and metabolic syndrome (MS). Older women not using hormone replacement therapy (HRT) also show distress-MS-CHD links, unlike HRT users.

Area of Science:

  • Gerontology and Cardiovascular Health
  • Psychophysiology and Chronic Disease
  • Health Disparities in Older Adults

Background:

  • Chronic stress is a significant risk factor for cardiovascular disease.
  • The interplay between stress, psychophysiology, and coronary heart disease (CHD) may differ across demographic groups.
  • Understanding these pathways is crucial for targeted interventions in aging populations.

Purpose of the Study:

  • To test a theoretical stress model examining the relationships between chronic stress, psychophysiology, and CHD.
  • To investigate potential variations in these relationships among older men, women not using hormone replacement therapy (HRT), and women using HRT.
  • To identify specific pathways linking chronic stress to CHD in different subgroups of older adults.

Main Methods:

  • Cross-sectional and prospective study design utilizing structural equation modeling.
  • Assessment of chronic stress (e.g., spousal caregiving), vulnerability (anger, hostility), social resources, psychological distress, health habits, and the metabolic syndrome (MS).
  • Longitudinal analysis of pathways to CHD over 27–30 months.

Main Results:

  • Older men with chronic stress (caregiving) showed higher CHD prevalence, mediated by distress, MS, and health habits.
  • In men, poor health habits predicted MS, which in turn predicted new CHD cases.
  • Older women not using HRT exhibited distress-MS and MS-CHD relationships over time, while HRT users did not show these psychophysiological pathways.

Conclusions:

  • Chronic stress significantly impacts older men's cardiovascular health through distress and metabolic syndrome.
  • Older women not using HRT demonstrate a similar, though less pronounced, stress-cardiovascular pathway.
  • Hormone replacement therapy in older women appears to attenuate the psychophysiological pathways linking stress, metabolic syndrome, and CHD.
Abstract

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