Elsevier

American Heart Journal

Volume 192, October 2017, Pages 1-12
American Heart Journal

Trial Design
Cumulative psychological stress and cardiovascular disease risk in middle aged and older women: Rationale, design, and baseline characteristics

https://doi.org/10.1016/j.ahj.2017.06.012Get rights and content

Although a growing body of evidence indicates strong links between psychological stress (stress) and untoward cardiovascular disease (CVD) outcomes, comprehensive examination of these effects remains lacking. The “Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle Aged and Older Women” study is embedded within the landmark Women's Health Study (WHS) follow-up cohort and seeks to evaluate the individual and joint effects of stressors (cumulative stress) on incident CVD risk, including myocardial infarction, stroke, coronary revascularization and CVD death. GWAS data will be used for exploratory analyses to identify any genes associated with stress and CVD. This study prospectively follows 25,335 women (mean age 72.2 ± 6.04 years) without CVD who returned a short mailed stress questionnaire at baseline and 3 years of follow-up inquiring about their experiences with stress including perceived stress, work stress, work-family spillover, financial stress, traumatic and major life events, discrimination and neighborhood environment/stressors. Other domains ascertained were sleep, anger, cynical hostility, depression, anxiety, social support, intimate partner relations, and volunteer and social activities. Higher levels of cumulative stress were associated with younger age and black race/ethnicity, divorced or separated marital status, increased prevalence of obesity, smoking, diabetes, depression and anxiety (p<0.001 for each). Findings from this study will provide clinically important, new information about associations of cumulative stress, environmental, lifestyle and genetic factors with incident CVD risk in aging women.

Section snippets

Study design overview

From Spring 2012 to Summer 2013, invitation letters, informed consent forms and the stress questionnaire were mailed to potential participants from the WHS cohort. WHS is a randomized, double blind, placebo-controlled, mail-based 2×2×2 factorial trial of low dose aspirin (100 mg every other day), vitamin E (600 IU every other day) and beta-carotene (50 mg on alternate days) in the primary prevention of cancer and CVD among 39,876 female health professionals aged ≥45 years old. We do not expect

Results

These data reflect baseline results measured at time-point #1 (2012–2013) only. Table I displays the baseline characteristics of the 25,335 participants that comprise the cumulative psychological stress cohort, stratified by cumulative stress score quartile. Mean age of participants is 72.2 ± 6.04 years. Participants that reported higher levels of stress were younger, tended to be black race/ethnicity and more likely to be divorced or separated but less likely to be widowed. Possible CVD risk

Discussion

In this cumulative chronic psychological stress study of cardiovascular disease in middle and older aged women, the cumulative and PSS scores were modestly correlated. The correlation between each individual stress domain score and cumulative stress (excluding the same individual score) is stronger than the correlation with the Cohen perceived stress score. This suggests that cumulative stress is picking up a type of information that is not well represented by the PSS.

Although, associations

Acknowledgements

The Cumulative Chronic Psychological Stress Study in Middle-Aged and Older Women is funded by RO1 AG038492 from the National Institute on Aging (NIA) to Michelle A. Albert, MD MPH and further supported by grants from the National Cancer Institute (CA047988) and National, Heart, Lung and Blood Institute (HL043851, HL080467, HL099355) that fund the overall WHS ongoing cohort follow-up. Much gratitude to the participants of the Women's Health Study ongoing cohort for their enthusiastic

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