title: Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men.
abstract: OBJECTIVE
  To prospectively investigate the association between self-reported psychosocial stress and long-term cardiovascular (CV) morbidity and mortality in a population-based cohort.
  
  
  RESULTS
  The Malmö Preventive Project is a population-based screening and intervention programme for cardiovascular disease (CVD) risk factors. Between 1974 and 1980, a total of 13,609 (2741 women) individuals, mean age 45 years, had self-reported chronic stress determined by questionnaire. CV morbidity and mortality were followed up in national registries. Median follow-up time was 21 years. The risk ratio (RR) for a fatal or nonfatal CV incident in the men and women of the group reporting chronic stress was 1.27 (95% CI 1.15-1.39). After stepwise adjustments for known CV risk factors, the RR was reduced to 1.14 (1.02-1.28). The highest RR was found for fatal stroke in men reporting chronic stress, 2.04 (1.07-3.88). For women alone, there was no significant increase in risk after adjustments.
  
  
  CONCLUSIONS
  Self-reported chronic stress is an independent risk factor for CVD, particularly fatal stroke, in middle-aged men; it continues to be a risk factor after adjustment for several other known risk factors. The adjustment itself might reflect mechanisms whereby psychosocial stress directly or indirectly exerts its effects on the body, indicating a possible over-adjustment.
authors.affiliation: Department of Medicine, University Hospital, S-205 02 Malmö, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Ohlin
authors.forename: P M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: J-A
authors.initials: JA
authors.lastname: Nilsson
authors.forename: G
authors.initials: G
authors.lastname: Berglund
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality / Q000523:psychology*; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013315:Stress, Psychological / Q000401:mortality*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014504:Urban Health