title: Perceived stress is associated with incident coronary heart disease and all-cause mortality in low- but not high-income participants in the Reasons for Geographic And Racial Differences in Stroke study.
abstract: BACKGROUND
  Perceived stress may increase risk for coronary heart disease (CHD) and death, but few studies have examined these relationships longitudinally. We sought to determine the association of perceived stress with incident CHD and all-cause mortality.
  
  
  RESULTS
  Data were from a prospective study of 24 443 participants without CHD at baseline from the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) study cohort. Outcomes were expert-adjudicated acute CHD and all-cause mortality. Over a mean follow-up of 4.2 (maximum 6.9) years, there were 659 incident CHD events and 1320 deaths. Analyses were stratified by income level because of significant interactions with stress. For individuals with low income, 3529 (35.4%) reported high stress, and for those with high income, 2524 (22.1%) did so. Compared with reporting no stress, those reporting the highest stress had higher risk for incident CHD if they reported low income (sociodemographic-adjusted HR 1.36, 95% CI: 1.04, 1.78) but not high income (sociodemographic-adjusted HR 0.82, 95% CI: 0.57, 1.16); the finding in low income individuals attenuated with adjustment for clinical and behavioral factors (HR 1.29, 95% CI: 0.99, 1.69, P=0.06). After full adjustment, the highest stress category was associated with higher risk for death among those with low income (HR 1.55, 95% CI: 1.31, 1.82) but not high income (HR 1.13, 95% CI: 0.88, 1.46).
  
  
  CONCLUSIONS
  High stress was associated with greater risks of CHD and death for individuals with low but not high income.
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Nicole
authors.initials: N
authors.lastname: Redmond
authors.forename: Joshua
authors.initials: J
authors.lastname: Richman
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Gamboa
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Albert
authors.forename: Mario
authors.initials: M
authors.lastname: Sims
authors.forename: Raegan W
authors.initials: RW
authors.lastname: Durant
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Glasser
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D002423:Cause of Death; D003327:Coronary Disease / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D007182:Income / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: epidemiology; mortality; myocardial infarction; stress