Associations of Cumulative Perceived Stress with Cardiovascular Risk Factors and Outcomes: Findings from the Dallas Heart Study

There is increasing evidence of a link between chronic stress and cardiovascular disease. Prior studies in this space have been limited by incomplete assessments of perceived stress or focus on single domains such as work stress or marital stress. In this study, presented at #AHA23, we focused on the intersection of chronic stress and cardiovascular disease in the Dallas Heart Study population.

A novel measure of cumulative perceived stress was created, which integrated generalized, psychosocial, financial, and neighborhood perceived stress – all of which we termed the cumulative stress score (CSS). This study is unique in that we further explored relationships between both the cumulative stress score and its subcomponents on cardiovascular risk factors, intermediate cardiovascular phenotypes, cardiovascular outcomes, and all-cause mortality.

We found that even after adjusting for risk factors such as high blood pressure, high cholesterol, smoking, and Type 2 diabetes, as well as income and education, higher CSS was associated with incident cardiovascular disease (CVD). Interestingly, cumulative stress was higher among women, Black and Hispanic participants, younger individuals, and people with lower income and educational attainment and was associated with adverse health behaviors and increased burden of CVD risk factors.

These findings suggest that multidimensional, comprehensive screening assessments of perceived stress may be beneficial in identifying individuals at risk for CVD. To our knowledge, this is the first study to provide such a multidimensional analysis of the relationships between perceived stress and CVD. Future studies will be needed to validate these findings and uncover further mechanisms that mediate the association between chronic stress and cardiovascular disease.

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