Social Role–Related Stress and Social Role–Related Reward as Related to Subsequent Subclinical Cardiovascular Disease in a Longitudinal Study of Midlife Women: The Study of Women's Health Across the Nation

OBJECTIVE: The purpose of this study was to determine if midlife social role quality, defined by the stress and rewards associated with four social roles, is related to later-life subclinical cardiovascular disease (SCVD) in a cohort of women transitioning through menopause. METHODS: The Study of Women's Health Across the Nation (SWAN) is a longitudinal cohort study of midlife women. Stress and reward from four social roles (spouse, parent, employee, caregiver) were assessed at seven early visits. Later-life SCVD was assessed via carotid ultrasound and brachial-ankle pulse wave velocity at two later visits. We tested whether ever reporting an "extremely" or "quite a bit" stressful role was related to SCVD. We also tested whether cumulative stress and reward, as well as baseline and change in stress and reward were related to SCVD, adjusting for demographics and cardiovascular risk factors. RESULTS: Among 1602 women, reporting a stressful role during midlife (between ages 47 and 52 years) was associated with later-life (age 61 years) carotid intima-media thickness, which was 21 μm thicker than never reporting a stressful role. No significant relationships between stressful roles and other SCVD measures were identified. Cumulative and baseline change models of stress and reward were not related to SCVD. CONCLUSION: A stressful social role in midlife was associated with greater atherosclerotic burden in later-life in a cohort of women transitioning through menopause. Social role rewards were unrelated to better later-life SCVD. These findings extend the knowledge of stress and cardiovascular disease in women by using measures of stress and reward for multiple social roles over the years of midlife.