Stress linked to CVD, death across low-, middle-, high-income countries
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Psychosocial stress was significantly associated with CVD, as well as major CHD, stroke events and death in individuals from low-, middle- and high-income countries, according to a cohort study.
“This cohort study found that stress was independently associated with a higher risk of CVD and deaths,” Ailiana Santosa, MD, MMedSc, PhD, of the University of Gothenburg in Sweden, and colleagues wrote. “Our findings emphasize the need for the development and evaluation of prevention strategies to address whether modifying stress would reduce CVD.”
The population-based study sought to assess the effects of stress on heart conditions such as CVD from individuals across five continents and ranging from high income to low income, to evaluate areas often less studied. To assess these outcomes, the researchers used data from the PURE study collected from January 2003 to March 2021. Participants lived across 21 countries, including Canada, Saudi Arabia, Brazil, Tanzania and India among others, and their ages ranged from 35 to 70 years.
The researchers assessed 118,706 participants (mean age, 50 years; 59% women) without prior CVD from baseline to follow-up, with 7.3% reporting high stress, 18.4% reporting moderate stress, 29.4% reporting low stress and 44.8% reporting no stress. During a median follow-up of 10.2 years, there were 5,934 CVD events, 4,107 CHD events and 2,880 stroke events, with 7,248 deaths in total.
Compared with no stress, progressive increase in stress conferred elevated risk for death (HR for low stress vs. no stress = 1.09; 95% CI, 1.03-1.16; HR for high stress vs. no stress = 1.17; 95% CI, 1.06-1.29) and for CHD (HR for low stress vs. no stress = 1.09; 95% CI, 1.01-1.18; HR for high stress vs. no stress = 1.24; 95% CI, 1.08-1.42), according to the researchers.
Santosa and colleagues also found an association with high stress and CVD (HR = 1.22; 95% CI, 1.08-1.37) as well as stroke (HR = 1.3; 95% CI, 1.09-1.56), but found no link between low or moderate stress and CVD or stroke. The researchers adjusted the results for age, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, family history of CVD and center random effects.
“The risk of death and congestive heart disease increased significantly as the level of stress increased, while high, but not low or moderate, stress was associated with CVD and stroke after adjustment for sociodemographic factors and health risk behaviors,” Santosa and colleagues wrote. “These findings emphasize the need for the development and evaluation of prevention strategies to address stress.”
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