Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study

Tiwaloluwa A Ajibewa; Kiarri N Kershaw; J Jeffrey Carr; James G Terry; Kelley Pettee Gabriel; Mercedes R Carnethon; Mandy Wong; Norrina B Allen

doi:10.1016/j.amepre.2023.12.015

Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study

Am J Prev Med. 2023 Dec 23:S0749-3797(23)00516-0. doi: 10.1016/j.amepre.2023.12.015. Online ahead of print.

Authors

Tiwaloluwa A Ajibewa¹, Kiarri N Kershaw², J Jeffrey Carr³, James G Terry³, Kelley Pettee Gabriel⁴, Mercedes R Carnethon², Mandy Wong², Norrina B Allen²

Affiliations

¹ Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: tiwaloluwa.ajibewa@northwestern.edu.
² Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
³ Vanderbilt University Medical Center, Nashville, Tennessee.
⁴ University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 38143043
DOI: 10.1016/j.amepre.2023.12.015

Abstract

Introduction: Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations.

Methods: Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables.

Results: The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05).

Conclusions: Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.