Key result
Perceiving stress adversely affects health is linked to ~49% greater risk of coronary death or MI.
Why the study?
It was unknown whether the perceived impact of stress on health is associated with adverse health outcomes such as coronary heart disease.
Does the perception that stress adversely affects health increase the risk of coronary heart disease in adults?
Cohort (n=7,268)
Does the perception that stress adversely affects health increase the risk of coronary heart disease in adults?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The main message is that complaints from patients concerning the effect of stress on their health should not be ignored in a clinical environment, because they may indicate an increased risk of developing and dying of coronary disease. Future studies of stress should include perceptions of patients concerning the effect of stress on their health.”
“We found that the association we observed between an individual's perception of the impact of stress on their health and their risk of a heart attack was independent of biological factors, unhealthy behaviours and other psychological factors.”
“We are increasingly aware of the links between a healthy mind and a healthy body, and this study raises the possibility that feeling stressed might slightly increase the risk of heart disease. However, such a link is not completely proven by the current study. Three percent of people who did not feel at all stressed suffered heart disease years later, whereas the figure was five percent in those who felt the most stressed. Clearly stress isn't the major cause of heart disease if it happens so often in non-stressed people and only a little more in very stressed people.”
Supports further investigation of stress perception as a risk marker; should not yet alter clinical practice.
AIM: Response to stress can vary greatly between individuals. However, it remains unknown whether perceived impact of stress on health is associated with adverse health outcomes. We examined whether individuals who report that stress adversely affects their health are at increased risk of coronary heart disease (CHD) compared with those who report that stress has no adverse health impact. METHODS AND RESULTS: Analyses are based on 7268 men and women (mean age: 49.5 years, interquartile range: 11 years) from the British Whitehall II cohort study. Over 18 years of follow-up, there were 352 coronary deaths or first non-fatal myocardial infarction (MI) events. After adjustment for sociodemographic characteristics, participants who reported at baseline that stress has affected their health 'a lot or extremely' had a 2.12 times higher (95% CI 1.52-2.98) risk of coronary death or incident non-fatal MI when compared with those who reported no effect of stress on their health. This association was attenuated but remained statistically significant after adjustment for biological, behavioural, and other psychological risk factors including perceived stress levels, and measures of social support; fully adjusted hazard ratio: 1.49 (95% CI 1.01-2.22). CONCLUSIONS: In this prospective cohort study, the perception that stress affects health, different from perceived stress levels, was associated with an increased risk of coronary heart disease. Randomized controlled trials are needed to determine whether disease risk can be reduced by increasing clinical attention to those who complain that stress greatly affects their health.
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Nabi et al. (2013) reported a cohort. Perception that stress adversely affects health 'a lot or extremely' vs. Perception that stress has no adverse health impact was evaluated on Coronary death or first non-fatal myocardial infarction (MI) (HR 1.49, 95% CI 1.01-2.22). The perception that stress adversely affects health 'a lot or extremely' was associated with an increased risk of coronary death or non-fatal MI (fully adjusted HR 1.49; 95% CI 1.01-2.22).
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