Associations of stressful life events and social strain with incident cardiovascular disease in the Women's Health Initiative

Kiarri N. Kershaw*, Gretchen A. Brenes, Luenda E. Charles, Mace Coday, Martha L. Daviglus, Natalie L. Denburg, Candyce H. Kroenke, Monika M. Safford, Tina Savla, Hilary A. Tindle, Lesley F. Tinker, Linda Van Horn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Background-Epidemiologic studies have yielded mixed findings on the association of psychosocial stressors with cardiovascular disease (CVD) risk. In this study, we examined associations of stressful life events (SLE) and social strain with incident coronary heart disease (CHD) and stroke (overall, and for hemorrhagic and ischemic strokes) independent of sociodemographic characteristics, and we evaluated whether these relationships were explained by traditional behavioral and biological risk factors. Methods and Results-Data from approximately 82 000 Women's Health Initiative Observational Study participants were used for the SLE and social strain analyses, respectively. Participants were followed for events for up to 18.0 years (median, 14.0). Separate Cox proportional hazards models were generated to estimate associations of each stress measure with incident CVD. After adjusting for sociodemographic characteristics and depressive symptoms, higher SLE and social strain were associated with higher incident CHD and stroke (each P trend < 0.05). Hazard ratios and 95% confidence intervals were 1.12 (1.01, 1.25) for incident CHD and 1.14 (1.01, 1.28) for incident stroke among participants reporting high versus low SLE. Findings were similar for social strain. Associations were attenuated with further adjustment for mediating behavioral and biological risk factors. Findings were similar for associations of SLE with ischemic stroke and hemorrhagic stroke, but social strain was only associated with ischemic stroke. Conclusions-Higher SLE and social strain were associated with higher incident CVD independent of sociodemographic factors and depressive symptoms, but not behavioral and biological risk factors.

Original languageEnglish (US)
Article number000687
JournalJournal of the American Heart Association
Volume3
Issue number3
DOIs
StatePublished - 2014

Keywords

  • Cardiovascular diseases
  • Epidemiology
  • Stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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