title: Associations of stressful life events and social strain with incident cardiovascular disease in the Women's Health Initiative.
abstract: BACKGROUND
  Epidemiologic studies have yielded mixed findings on the association of psychosocial stressors with cardiovascular disease (CVD) risk. In this study, we examined associations of stressful life events (SLE) and social strain with incident coronary heart disease (CHD) and stroke (overall, and for hemorrhagic and ischemic strokes) independent of sociodemographic characteristics, and we evaluated whether these relationships were explained by traditional behavioral and biological risk factors.
  
  
  RESULTS
  Data from approximately 82 000 Women's Health Initiative Observational Study participants were used for the SLE and social strain analyses, respectively. Participants were followed for events for up to 18.0 years (median, 14.0). Separate Cox proportional hazards models were generated to estimate associations of each stress measure with incident CVD. After adjusting for sociodemographic characteristics and depressive symptoms, higher SLE and social strain were associated with higher incident CHD and stroke (each P trend <0.05). Hazard ratios and 95% confidence intervals were 1.12 (1.01, 1.25) for incident CHD and 1.14 (1.01, 1.28) for incident stroke among participants reporting high versus low SLE. Findings were similar for social strain. Associations were attenuated with further adjustment for mediating behavioral and biological risk factors. Findings were similar for associations of SLE with ischemic stroke and hemorrhagic stroke, but social strain was only associated with ischemic stroke.
  
  
  CONCLUSIONS
  Higher SLE and social strain were associated with higher incident CVD independent of sociodemographic factors and depressive symptoms, but not behavioral and biological risk factors.
authors: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K., M.L.D., L.V.H.).
authors: Kiarri N
authors: KN
authors: Kershaw
authors: Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, NC (G.A.B.).
authors: Gretchen A
authors: GA
authors: Brenes
authors: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV (L.E.C.).
authors: Luenda E
authors: LE
authors: Charles
authors: Departments of Preventive Medicine and Psychiatry, University of Tennessee Health Science Center, Memphis, TN (M.C.).
authors: Mace
authors: M
authors: Coday
authors: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K., M.L.D., L.V.H.) Department of Medicine, University of Illinois at Chicago, Chicago, IL (M.L.D.).
authors: Martha L
authors: ML
authors: Daviglus
authors: Department of Neurology, University of Iowa Carver College of Medicine, Des Moines, IA (N.L.D.).
authors: Natalie L
authors: NL
authors: Denburg
authors: Kaiser Permanente Division of Research, Oakland, CA (C.H.K.).
authors: Candyce H
authors: CH
authors: Kroenke
authors: Department of Medicine, University of Alabama Birmingham, Birmingham, AL (M.M.S.).
authors: Monika M
authors: MM
authors: Safford
authors: Department of Human Development, Virginia Polytechnic Institute and State University, Blacksburg, VA (T.S.).
authors: Tina
authors: T
authors: Savla
authors: Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA (H.A.T.).
authors: Hilary A
authors: HA
authors: Tindle
authors: Women's Health Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA (L.F.T.).
authors: Lesley F
authors: LF
authors: Tinker
authors: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K., M.L.D., L.V.H.).
authors: Linda
authors: L
authors: Van Horn
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008875:Middle Aged; D016016:Proportional Hazards Models; D011584:Psychology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000706:statistics & numerical data
keywords: cardiovascular diseases; epidemiology; stress