Table 1 Results of Studies of Stress and Cardiovascular Disease Events in Mid-life Women
From: Women’s heart health at mid-life: what is the role of psychosocial stress?
Author, Year, Study Name/Brief Description | N (% women) | Age Range | Mean Age (SD or SE) | Stratified by Sex or tested Stress X Sex Interactiona | Study design | Outcome | Stress measure | Results | QAT Rating |
|---|---|---|---|---|---|---|---|---|---|
Bohley et al., 2016, Population based study of East German adults [40] | 3901 (49%) | 20–83 | Women: 48.8 (12.1) | Stratified | Cross-sectional | CHD (MI, CABG, PCI), and CVD (CHD or stroke) (Self-report) | Stressors related to German Reunification (financial, occupational, personal) | Reunification stress related to greater prevalence of CHD in women only. | Fair |
Buyck et al., Whitehall II, 2013 [48] | 7925 (31%) | 39–63 | 49.5 (6.1) | Stratified | Prospective | CHD (fatal CHD, MI, angina) (Hospital record/self-report/verified with ECG) | Caregiving status, burden (> 5 vs < 5 h/week), duration | CHD risk did not differ between caregivers and non-caregivers. Caregiving burden and duration also not associated with greater CHD risk. | Fair |
Dunlay et al., 2017, Jackson Heart Study [50] | 5085 (64%) | 21–94 | 55.3 (12.8) | Interaction (n.s.) | Prospective | Incident CHD, stroke or heart failure (Adjudicated) | Everyday Discrimination, Lifetime Discrimination | No association between discrimination and CVD outcomes. | Good |
Egido et al., 2012, A case-control study of stress and stroke [41] | 450 (50%) | 18–65 | 53.8 (9.3) | Interaction (n.s) | Case-control | Stroke (Hospital record) | Holmes & Rahe Questionnaire of Life Events | Stroke patients had higher odds of stressful life events than neighborhood controls. | Good |
Everson-Rose et al., 2014, MESA [34] | 6749 (53%) | 45–84 | 62.1 (10.2) | Interaction (n.s.) | Prospective | Incident stroke, TIA (Adjudicated) | Chronic Burden Scale | Higher levels of chronic stress burden associated with increased risk of stroke or TIA. | Good |
Everson-Rose et al., 2015, MESA [51] | 6508 (53%) | 45–84 | 62 (10.2) | Interaction (n.s.) | Prospective | Incident CVD events (adjudicated) | Everyday Discrimination, Lifetime discrimination | Lifetime discrimination in ≥2 domains related to greater risk of CVD events. Everyday discrimination not related to CVD events in women. | Good |
Gallo et al., 2014, HCHS/SOL SCAS [39] | 5313 (62%) | 18–74 | Not reported, 62% of sample age 45–74 | Interaction (n.s.) | Cross-sectional | Prevalent CVD (Self-report) | Chronic Burden Scale, Perceived Stress Scale, Traumatic Stress Screener | Chronic stress, but not PSS or traumatic stress, significantly related to prevalent CHD. | Good |
Graff et al., 2017, Danish National Health Survey [38] | 114,337 (54%) | 25+ | Not reported, majority 45–65 | Interaction (n.s.) | Prospective | Atrial Fibrillation (Patient register) | Perceived Stress Scale | No significant association between PSS and 4-year AF incidence after adjustment for comorbidities, SES and lifestyle factors. | Good |
Guiraud et al., 2013, A case-crossover study of ischemic stroke and stress [42] | 247 (42%) | 18+ | 61.3 (15.9) | Interaction (n.s.) | Case-crossover | Stroke (Hospital record) | Interview for Recent Life Events | Stroke patients experienced ≥1 life event more often during first month and week preceding stroke than during control periods. | Fair |
Jood et al., 2017, A case-control study of stress and stroke [45] | 594 (32%) | 30–65 | 54.4 (7.9) | Stratified | Case-control | Stroke (Hospital record) | Past 12-month job strain, Effort-reward imbalance (ERI), Work conflicts | Job strain, conflict at work, and ERI all higher in stroke cases than community controls. | Fair |
Kershaw et al., 2014, Women’s Health Initiative Study [32] | 82,000 (100%) | 52–72 | Women: 62.1 (0.05) | N/A | Prospective | CHD and stroke (Adjudicated) | Life events, Social strain | Life events and social strain related to increased CVD, but not after adjusting for behavioral and biological risk factors. | Good |
Kershaw et al., 2015, MESA [33] | 6678 (50%) | 45–84 | 62.4 (0.2) | Interaction (n.s.) | Prospective | Incident CHD (Adjudicated) | Chronic Burden Scale (Individual stress), Neighborhood-level stress | High tertile individual chronic stress and medium tertile neighborhood chronic stress associated with greater incident CHD. | Good |
Kriegbaum et al., 2013, Danish Population Study [47] | 42 million (50%) | 30–65 | Not reported, age range 30–65 | Stratified | Prospective | MI (Registry) | Broken partnership | Broken partnerships were associated with increased risk of incident MI in the year of the break-up and in subsequent years. The association varied by age, with MI risk of same-year break-up significant among older women (50–65) but not younger women (30–49). | Good |
Lazzarino et al., 2013, Health Survey for England [35] | 66,518 (54%) | 35+ | 55.1 (13.8) | Stratified | Prospective | CVD mortality (Vital registration) | Psychological distress | Greater psychological distress associated with risk of CVD death. | Good |
Morton et al., 2014, MIDUS [49] | 3032 (52%) | 25–74 | Not reported | Stratified | Prospective | MI (Self-report) | Family strain (demands, criticism, let down, get on nerves) | Family strain in mid-life not related to MI. | Fair |
Ogilvie et al., 2016, MESA [36] | 6809 (53%) | 45–84 | 62.2 (10.2) | Interaction (n.s.) | Prospective | Heart failure (Adjudicated) | Chronic Burden Scale | High baseline chronic stress not related to increased risk of heart failure | Good |
O’Neal et al., 2015, REGARDS [37] | 25,530 (54%) | Not reported | 65 (9.4) | Stratified | Cross-sectional | Atrial Fibrillation (ECG) | Perceived Stress Scale | PSS significantly related to AF, even after adjustment for covariates. | Fair |
Padyab et al., 2014, Swedish Intervention Program [43] | 74,988 (51%) | 40–60 | 49 (8) | Stratified | Prospective | CVD mortality (Registry) | Karasek job strain model (demand, control) | Job demand, control, and job strain not associated with CVD risk. | Good |
Redmond et al., 2013, REGARDS [31] | 24,439 (55%) | Not reported | 64.1 (9.3) | Interaction (n.s.) | Prospective | Incident CHD, Incident fatal CHD (Adjudicated) | Perceived Stress Scale | Participants with a stress score in the highest tertile had a greater risk of incident CHD, in low income group only (<$35,000). | Good |
Slopen et al., 2012, Women’s Health Study [46] | 22,086 (100%) | Not reported | Women: 57.2 (5.2) | N/A | Prospective | Incident CVD (MI, stroke, CABG, PCI or CVD death) (Adjudicated) | Job strain, Job insecurity | Job strain, but not insecurity, related to incident CVD. Women with “active” jobs (high demand, high control) also had an increased CVD risk. | Good |
Svensson et al., 2017, Malmö Diet and Cancer Study [44] | 18,559 (62%) | 45–73 | 58.3 (8.0) | Interaction (n.s.) | Prospective | CAD (MI, CABG, PCI); fatal MI; non-fatal MI; CVD death (Government Registries) | Job strain, non-work stress | Combined work and non-work stress index unrelated to CAD, MI or CVD death. | Good |
Udo et al., 2016, NESARC [52] | 21,357 (53%) | 18+ | 46.2 (16.4) | Stratified | Cross-sectional | self-reported MI, stroke, arteriosclerosis | Perceived weight discrimination, Stressful life events | Perceived weight discrimination associated with arteriosclerosis and MI in women only. | Poor |