Cardiovascular disease, perceived stress, and physical activity: population-level associations relevant to...

Medical advances have markedly improved survival among patients with cardiovascular disease (CVD). Psychosocial and behavioral factors, including stress and physical activity, are increasingly recognized as key determinants of outcomes in this population. We investigated the association between existing CVD and perceived stress and examined how this association was modulated by physical activity levels in a Danish cohort, accounting for physiological and psychosocial conditions. We analyzed data on 102,650 Danish residents aged 50-65 yr by linking self-reported questionnaire data from the Better Health in Late Life cohort with national health registry data. CVD was identified using hospital discharge diagnoses. Stress was measured with the 10-item Perceived Stress Scale. Physical activity was assessed with a pilot-tested questionnaire. Seven percent of participants had CVD. Compared with those without CVD, they had a higher prevalence of moderate-to-high perceived stress (42% vs. 33%) and a slightly lower prevalence of meeting guideline-recommended physical activity (42% vs. 45%). High stress was associated with physical activity not meeting the recommended level in both groups; however, this association was stronger among those with versus without CVD {prevalence ratio 2.01 [95% confidence interval (CI): 1.89-2.14] vs. 1.52 (95% CI: 1.48-1.56)}. We observed similar associations between stress and cardiovascular risk factors, comorbidity, psychosocial factors, and socioeconomic status. The association between stress and low physical activity persisted after stratification by these conditions. In conclusion, high stress was most strongly associated with low physical activity among adults with CVD. The underlying mechanisms seem to extend beyond physiological pathways and need further investigation.NEW & NOTEWORTHY In this population-based study of over 100,000 Danish adults, participants with cardiovascular disease reported higher perceived stress than those without. Elevated stress was associated with low physical activity across all participants, particularly among those with cardiovascular disease, but also with medical, psychosocial, and behavioral factors. These findings highlight the complex interplay between physiological and nonphysiological determinants of stress, underscoring the importance of integrating stress management and physical activity promotion into cardiovascular prevention and management strategies.