Stress and cardiovascular disease: Testing a vigilance pathway in two contemporary theories

Despite robust evidence linking psychological stress to cardiovascular disease (CVD), explanations for how risk is transmitted are limited by a lack of ecologically valid models. Recent conceptual advances including generalized unsafety theory of stress and social safety theory articulate persistent physiological activation driven by contextual exposure and compensatory situational vigilance as a pathway. This study provides an integrated first test of generalized unsafety theory of stress and social safety theory models on preclinical CVD.

A diverse community sample of 300 adults (M_age = 42.44 years; 50% women; 60% non-Hispanic (NH) Whites, 19% Hispanic/Latinos, 15% NH Blacks, 6% NH Others) completed a 2-year longitudinal study with surveys, ecological momentary assessment (EMA), and carotid artery scans measuring disease progression. Residential data were geo-coded to assess risk for crime exposure. Data collection occurred in 2012 and 2014.

As hypothesized, greater environmental unsafety (geo-coded crime rates; B = 0.02, p < .05) and greater daily social vigilance (EMA self-report; Bs = 0.09, ps < .05) were associated with greater disease progression. Although higher daily social safety (EMA self-report; B = -0.04, p < .001) was associated with lower social vigilance, social vigilance did not mediate associations between either safety indicator and disease progression.

Results align with a persistent activation conceptualization of stress and modestly support the specific theoretical assertions. These findings suggest future stress-CVD investigations should account for multilevel safety influences and continuous monitoring behavior to more accurately capture daily stress experiences. (PsycInfo Database Record (c) 2026 APA, all rights reserved).