Perceived psychosocial stress and cardiovascular risk factors in obese and non-obese patients

Patients after their first myocardial infarction are characterized by increased levels of perceived stress and abdominal obesity compared to a matched control group. In the setting of primary prevention, the association of stress and cardiovascular risk factors in obese and non-obese individuals is not known.

For this prospective cross-sectional study, primary care physicians recruited consecutive patients with BMI >30 and the next two individuals presenting with a BMI < 30 as controls (n=414). The 10-year risk of death from cardiovascular disease determined by the European Society of Cardiology HeartScore Germany was associated with BMI (p<0.0001). However, waist circumference and waist-to-hip ratio predicted the calculated cardiovascular risk better than BMI. Psychosocial risk factors were determined using the INTERHEART questionnaire. Obesity was positively associated with depression (p=0.005) but not with perceived stress. In contrast to obesity or depression, the extent of perceived general stress inversely correlated with cardiovascular risk (never stress: 4.4+/-2.8%, some period: 2.4+/-2.7%, several periods: 1.4+/-2.3% and permanent: 0.65+/-0.5%; p=0.0001). Similarly, additional parameters of stress (stress at home, stress at work, financial stress, stressful life events) as well as locus of control were inversely associated with cardiovascular risk factors. A medical history of general stress was correlated with younger age and increased smoking.

Waist to hip ratio powerfully predicts the cardiovascular risk estimated by HeartScore in primary prevention. Perceived stress assessed by a standardized questionnaire does not positively correlate with traditional cardiovascular risk factors and warrants further evaluation as a routine tool for primary care physicians.