Key result
Higher composite stress score linked to ~22% greater risk of atherosclerotic and global CVD.
Why the study?
Most data linking chronic stress with CVD risk factors and outcomes have focused on single-domain stress measurements rather than composite measures in diverse populations.
Does a higher composite stress score associate with increased risk of cardiovascular disease in a diverse population without prevalent CVD?
Cohort (n=2,685)
Does a higher composite stress score associate with increased risk of cardiovascular disease in a diverse population without prevalent CVD?
A novel composite measure of chronic stress is independently associated with an increased risk of atherosclerotic and global cardiovascular disease over 12.4 years of follow-up.
Supports stress assessment in primary CVD prevention; hypothesis-generating for causal effects and interventions.
Background Most data linking chronic stress with cardiovascular disease (CVD) risk factors and outcomes have focused on single‐domain stress measurements. We evaluated the association between a novel composite measure of chronic perceived stress and CVD risk factors and outcomes in a diverse population. Methods and Results Individual chronic stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated to create a novel composite stress score (CSS). Participants from the DHS (Dallas Heart Study) phase 2 (2007–2009) visit without prevalent CVD who completed chronic stress questionnaires were included (n=2685). Associations between CSS and demographics, cardiac risk factors, and health behaviors were assessed in multivariable analyses. Cox proportional hazards models adjusting for traditional risk factors were used to determine associations of the CSS with adjudicated atherosclerotic CVD and global CVD (atherosclerotic CVD, heart failure, and atrial fibrillation) outcomes. CSS was higher among participants who were younger, women, and Black or Hispanic individuals, with lower income and educational attainment ( P <0.0001 for each). In multivariable regression models adjusting for age, sex, race and ethnicity, income and education, higher CSS associated with hypertension, smoking, higher body mass index, hemoglobin A 1C , high‐sensitivity C‐reactive protein, and sedentary time ( P <0.01 for each). Over a median follow‐up of 12.4 years, higher CSS associated with atherosclerotic CVD (adjusted hazard ratio [HR]. 1.22 per SD [95% CI, 1.01–1.47]) and global CVD (adjusted HR, 1.20 [95% CI, 1.03–1.40]). No interactions were seen between CSS, demographic factors, and outcomes. Conclusions Composite measures of chronic stress are higher in vulnerable populations and may help identify individuals at risk for CVD who may benefit from enhanced prevention strategies.
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Eleazu et al. (2025) conducted a cohort in Cardiovascular disease risk (n=2,685). Composite stress score (CSS) was evaluated on Atherosclerotic CVD (HR 1.22, 95% CI 1.01-1.47). A higher composite stress score was associated with an increased risk of atherosclerotic CVD (adjusted HR 1.22; 95% CI, 1.01-1.47) and global CVD over a median follow-up of 12.4 years.
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