title: Life stress and atherosclerosis: a pathway through unhealthy lifestyle.
abstract: OBJECTIVE
  To examine the relationship between a general measure of chronic life stress and atherosclerosis among middle aged adults without clinical cardiovascular disease via pathways through unhealthy lifestyle characteristics.
  
  
  METHODS
  We conducted an analysis of The Multi-Ethnic Study of Atherosclerosis (MESA). The MESA collected in 2000 includes 5,773 participants, aged 45-84. We computed standard regression techniques to examine the relationship between life stress and atherosclerosis as well as path analysis with hypothesized paths from stress to atherosclerosis through unhealthy lifestyle. Our outcome was sub-clinical atherosclerosis measured as presence of coronary artery calcification (CAC).
  
  
  RESULTS
  A logistic regression adjusted for potential confounding variables along with the unhealthy lifestyle characteristics of smoking, excessive alcohol use, high caloric intake, sedentary lifestyle, and obesity yielded no significant relationship between chronic life stress (OR 0.93, 95% CI 0.80-1.08) and CAC. However, significant indirect pathways between chronic life stress and CAC through smoking (p = .007), and sedentary lifestyle (p = .03) and caloric intake (.002) through obesity were found.
  
  
  CONCLUSIONS
  These results suggest that life stress is related to atherosclerosis once paths of unhealthy coping behaviors are considered.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, Charleston SC 29425, USA. mainouag@musc.edu
authors.forename: Arch G
authors.initials: AG
authors.lastname: Mainous
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Everett
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Diaz
authors.forename: Marty S
authors.initials: MS
authors.lastname: Player
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000523:psychology*; D002149:Energy Intake; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000150:complications*