Chronic Stress and Cardiovascular Health: The MESA and MASALA Studies

Research suggests that chronic stress is associated with individual cardiovascular health metrics (e.g., physical activity and diet quality); however, the association between chronic stress and overall cardiovascular health is less well understood. Furthermore, minoritized racial and ethnic groups experience a disproportionate stress burden. Therefore, this study assessed the association between chronic stress and cardiovascular health within 2 racially and ethnically diverse cohorts.

This study utilized pooled data from 7,978 participants of the Multi-Ethnic Study of Atherosclerosis and the Mediators of Atherosclerosis in South Asians Living in America studies collected in 2000-2011 and 2010-2018, respectively. The associations between chronic stress and the cross-sectional and annualized change in Life's Essential 8 cardiovascular health score, excluding sleep (range=0-100), were assessed using linear regression to adjust for sociodemographic factors. Anxiety, depression, and social support were assessed as potential moderators of this association. Analyses were repeated using individual cardiovascular health metrics as the outcome. Analyses were conducted in 2025.

In cross-sectional analyses, individuals with high chronic stress had a 2.7-point lower (-2.71, 95% CI= -3.46, -1.95) cardiovascular health score than those with no chronic stress after adjustments. No association between chronic stress and annualized change in cardiovascular health score was observed. In addition, there was no moderation by anxiety, depression, or social support.

Elevated chronic stress is adversely associated with concurrent cardiovascular health. These results highlight the important relationship between chronic stress and health.