Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study
Tiwaloluwa A Ajibewa1, Kiarri N Kershaw1, J Jeffrey Carr2
1Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Insights
Chronic stress increases cardiovascular disease risk, but this link is mediated by clinical factors, not social support or physical activity. Further research into protective psychological and behavioral factors is recommended.
Area of Science:
- Cardiovascular health
- Psychosocial factors
- Epidemiology
Background:
- Elevated perceived stress is linked to poor cardiovascular health.
- Positive psychological factors like social support and health behaviors may buffer stress-related cardiovascular risks.
- Longitudinal data is needed to understand stress, cardiovascular disease (CVD), and potential modifying factors.
Purpose of the Study:
- To investigate the longitudinal association between chronic stress and incident CVD events.
- To determine if social support and physical activity (PA) modify the relationship between chronic stress and CVD.
- To explore the role of clinical mediators in the stress-CVD relationship.
Main Methods:
- Analysis of 3,401 adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study (2000-2001 to 2020).
- Self-reported chronic stress (≥6 months across 5 domains), physical activity, and social support.
- Ascertainment of adjudicated fatal/nonfatal CVD events using multivariable stepwise Accelerated Failure Time analysis.
Main Results:
- Chronic stress was associated with reduced survival time (time ratio: 0.92; 95% CI: 0.854-0.989) after adjusting for sociodemographic and lifestyle factors.
- This association lost statistical significance when clinical factors were included in the model.
- Physical activity and social support did not significantly modify the association between chronic stress and CVD events (all p > 0.05).
Conclusions:
- Chronic stress is linked to increased CVD risk in middle-aged adults, partly through clinical mediators.
- Social support and physical activity did not appear to modify this association in this cohort.
- Further research is warranted to identify psychosocial and behavioral factors that may protect against stress-related cardiovascular disease.
Introduction:
Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations.
Methods:
Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables.
Results:
The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05).
Conclusions:
Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.
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