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Circulation. 2019 Feb 28. doi: 10.1161/CIRCULATIONAHA.118.033915. [Epub ahead of print]

Cumulative Psychosocial Stress and Ideal Cardiovascular Health in Older Women: Data by Race/Ethnicity.

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Department of Medicine, Duke University Medical Center, NC.
Cardiology, University of California, San Francisco, CA.
Department of Epidemiology and Biostatistics, University of Maryland College Park, MD.
Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, MA.
Preventive Medicine, Harvard Medical School, MA.
University of California-San Francisco, CA.



Research implicates acute and chronic stressors in racial/ethnic health disparities, but the joint impact of multiple stressors on racial/ethnic disparities in cardiovascular health is unknown.


In 25,062 women (N: White: 24,053; Hispanic: 256; Black: 440; Asian: 313) participating in the Women's Health Study (WHS) follow-up cohort, we examined the relationship between cumulative psychosocial stress (CPS) and ideal cardiovascular health (ICH), as defined by the American Heart Association Strategic 2020 goals. This health metric includes smoking, body mass index, physical activity, diet, blood pressure, total cholesterol and glucose, with higher levels indicating more ideal cardiovascular health and less cardiovascular risk (score range: 0-7). We created a CPS score which summarized acute (e.g. negative life events) and chronic stressors (e.g. work, work-family spillover, financial, discrimination, relationship and neighborhood) and traumatic life event stress reported on a stress questionnaire administered in 2012-2013 [score range 16-385, higher scores indicating higher levels of stress)].


White women had the lowest mean CPS scores (White: 161.7 ± 50.4; Hispanic: 171.2 ± 51.7; Black: 172.5 ± 54.9; Asian: 170.8 ± 50.6; p overall <0.01). Mean CPS scores remained higher in Hispanic, Black and Asian women compared to White women after adjusting for age, socioeconomic status (SES: income and education) and psychological status (depression and anxiety) [peach <0.01]. Mean ICH scores varied by race/ethnicity (p < 0.01), and were significantly lower in Black women and higher in Asian women when compared to White women (β coefficient and 95% Confidence Interval (CI): Hispanics -0.02: -0.13, -0.09; Blacks -0.34: -0.43, -0.25; Asians 0.34: 0.24, 0.45); control for SES and CPS did not change these results. Interactions between CPS and race/ethnicity in ICH models were not significant.


Both cumulative psychosocial stress and ideal cardiovascular health varied by race/ethnicity. ICH remained worst in Blacks and better in Asians compared to Whites, despite taking into account socioeconomic factors and cumulative psychosocial stress.


ideal cardiovascular health; psychoscocial stress

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