July 20, 2026Open Access
View Full PaperIncreased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study
Key Result
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).
Key Points
- To investigate whether individuals perceive stress as affecting their health and its association with coronary heart disease risk.
- Analyzed data from 7268 individuals in the British Whitehall II cohort study
- Follow-up period of 18 years was utilized to track coronary deaths and myocardial infarction events
- Adjusted for sociodemographic, biological, behavioral, and psychological risk factors in the analysis.
- Individuals reporting stress negatively impacting health had 2.12 times higher risk of coronary events (95% CI 1.52-2.98)
- After full adjustment, the association remained significant with a hazard ratio of 1.49 (95% CI 1.01-2.22)
- The relationship highlights a distinct factor beyond general perceived stress levels.
Study Design
Type
Cohort (n=7,268)
Structured PICO
Does the perception that stress adversely affects health increase the risk of coronary heart disease in adults?
P
Population
7,268 men and women from the British Whitehall II cohort study, followed for 18 years.
E
Exposure
Reporting at baseline that stress has affected their health 'a lot or extremely'
C
Comparator
Reporting no effect of stress on their health
O
Outcome
Coronary death or first non-fatal myocardial infarction (MI) eventshard clinical
Main Result
Hazard Ratio: 1.49 (95% CI 1.01–2.22)
Abstract
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.
Expert Takes3 quotes
1/3
“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.”