title: Informal caregiving and the risk for coronary heart disease: the Whitehall II study.
abstract: BACKGROUND
  The stress associated with informal caregiving has been shown to be associated with poor health, including coronary heart disease (CHD). However, it is unclear if the risk of CHD is attributable to caregiving or prior poor health of the caregiver.
  
  
  METHODS
  We used data from the Whitehall II cohort study. Caregiving and caregiver's health (using 3 measures: self-rated health, mental health using the General Health Questionnaire, and physical component score of the SF-36) were assessed in 1991-1993 among 5,468 men and 2,457 women aged 39-63 years. CHD (fatal CHD, clinically verified nonfatal myocardial infarction, and definite angina) incidence was recorded for a mean 17 years; sociodemographic variables, health behaviors, and cardiovascular risk factors were included as covariates.
  
  
  RESULTS
  Cox regression showed the risk of CHD in caregivers not to be higher (hazard ratio = 1.18; 95% CI: 0.96, 1.45) compared with noncaregivers. Analyses stratified by health status showed that compared with noncaregivers in good health, caregivers with poor self-rated (hazard ratio = 2.00; 95% CI: 1.44, 2.78), mental (hazard ratio = 1.63; 95% CI: 1.16, 2.30), or physical (hazard ratio =1.87; 95% CI: 1.34, 2.62) health had greater risk of CHD. A similar elevated risk was observed in noncaregivers with poor health; no excess risk was observed among caregivers reporting good health, and the combined effect of poor health and caregiving did not exceed their independent effects.
  
  
  CONCLUSIONS
  Caregiving in midlife is not in itself associated with greater risk of CHD, but it is associated with increased risk for CHD among caregivers who report being in poor health.
authors.affiliation: INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. Archana.Singh-Manoux@inserm.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Buyck
authors.forename: Joël
authors.initials: J
authors.lastname: Ankri
authors.forename: Aline
authors.initials: A
authors.lastname: Dugravot
authors.forename: Sophie
authors.initials: S
authors.lastname: Bonnaud
authors.forename: Hermann
authors.initials: H
authors.lastname: Nabi
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D013312:Stress, Physiological
keywords: Caregiver.; Coronary heart disease; Stress