Chronic financial stress and cardiovascular disease risk: A prospective cohort study and Mendelian randomization
1School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China.
Insights
Financial difficulties causing chronic stress significantly increase cardiovascular disease (CVD) risk. This risk is partly mediated by body composition, lifestyle, immunity, and metabolism changes.
Area of Science:
- Cardiovascular Science
- Psychosomatic Medicine
- Public Health
Background:
- Chronic stress is a known risk factor for cardiovascular diseases (CVDs), but the underlying mechanisms are not fully understood.
- This study investigates the association between chronic stress and incident CVDs, exploring potential mediating factors.
Purpose of the Study:
- To examine the relationship between chronic stress and the risk of developing CVDs.
- To identify and quantify the roles of metabolism, body composition, immunity, lifestyle, and cognitive function as mediators in this association.
Main Methods:
- Analysis of 399,998 UK Biobank participants without pre-existing CVDs.
- Utilized multivariable Cox proportional hazards models and two-sample Mendelian randomization (MR).
- Assessed mediators including body composition (waist-to-height ratio, hip-to-height ratio), lifestyle factors (smoking, sedentary behavior, sleep, diet), immunity markers (lymphocyte count, CRP), and metabolism (HbA1c).
Main Results:
- Chronic stress, particularly from financial difficulties, was linked to increased CVD risk.
- Financial difficulties-related chronic stress showed significant associations with stroke, coronary heart disease, myocardial infarction, and heart failure.
- Body composition (especially waist-to-height ratio), lifestyle, immunity, and metabolism collectively mediated 19.30%-34.40% of the effects of financial stress on CVDs.
Conclusions:
- Chronic stress stemming from financial difficulties is a significant risk factor for incident cardiovascular diseases.
- Body composition, lifestyle, immunity, and metabolism are key mediating pathways through which financial stress elevates CVD risk.
Background And Aims:
The associations between chronic stress and incident CVDs and related mechanisms remain understudied. This study examined these associations and explored the potential mediators, including metabolism, body composition, immunity, lifestyle, and cognitive function.
Methods:
We analyzed 399,998 participants without prior CVDs including stroke, coronary heart disease, myocardial infarction, or heart failure from the UK Biobank cohort. The multivariable Cox proportional hazards model was conducted to evaluate the associations between chronic stress and incident CVDs. Two-sample Mendelian randomization (MR) was used to further examine their associations. Candidate mediators included factors of metabolism, body composition, immunity, lifestyle, and cognitive function.
Results:
Chronic stress from serious illness/injury/assault of the participants or financial difficulties was associated with increased risk of CVDs, as revealed by the multivariable Cox proportional hazards model. MR analysis showed that only chronic stress from financial difficulties was associated with elevated risks of stroke (OR = 1.86, 95 %CI: 1.10-3.14), coronary heart disease (OR = 1.05, 1.02-1.07), myocardial infarction (OR = 1.03, 1.02-1.05), and heart failure (OR = 5.02, 2.60-9.71). Four groups of mediators collectively accounted for 19.30 %-34.40 % of the effects of chronic stress from financial difficulties on incident CVDs: Body composition explained 6.20 %-16.10 % (waist-to-height ratio: 14.80 %-26.20 % and hip-to-height ratio: 8.08 %-12.80 %), followed by lifestyle: 5.70 %-9.00 % (smoking: 3.94 %-6.68 %, sedentary behaviors: 1.59 %-3.71 %, sleep: 2.33 %-4.07 %, and refrain grain intake: 1.08 %-1.18 %), immunity: 4.60 %-8.60 % (lymphocyte count: 1.69 %-2.89 % and CRP: 7.62 %-12.10 %), and metabolism: 1.70 %-7.90 % (HbA1c: 5.39 %-8.91 %). The waist-to-height ratio was the strongest mediator.
Conclusions:
Chronic stress from financial difficulties is associated with elevated CVDs risk, which is mediated by body composition, lifestyle, immunity, and metabolism factors.
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