Kershaw Kiarri N, Brenes Gretchen A, Charles Luenda E, Coday Mace, Daviglus Martha L, Denburg Natalie L, Kroenke Candyce H, Safford Monika M, Savla Tina, Tindle Hilary A, Tinker Lesley F, Van Horn Linda
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K., M.L.D., L.V.H.).
Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, NC (G.A.B.).
J Am Heart Assoc. 2014 Jun 27;3(3):e000687. doi: 10.1161/JAHA.113.000687.
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.
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.
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.
流行病学研究对于心理社会压力源与心血管疾病（CVD）风险之间的关联得出了不一致的结果。在本研究中，我们考察了生活应激事件（SLE）和社会压力与冠心病（CHD）及中风（总体，以及出血性和缺血性中风）发病之间的关联，这些关联独立于社会人口学特征，并且我们评估了这些关系是否可以由传统行为和生物学风险因素来解释。
分别使用来自约82000名女性健康倡议观察性研究参与者的数据进行SLE和社会压力分析。对参与者随访事件长达18.0年（中位数为14.0年）。生成单独的Cox比例风险模型以估计每种压力测量与CVD发病之间的关联。在调整社会人口学特征和抑郁症状后，较高的SLE和社会压力与较高的CHD及中风发病率相关（各P趋势<0.05）。报告高SLE与低SLE的参与者中，CHD发病的风险比和95%置信区间为1.12（1.01，1.25），中风发病的风险比和95%置信区间为1.14（1.01，1.28）。社会压力的结果相似。在进一步调整中介行为和生物学风险因素后，关联减弱。SLE与缺血性中风和出血性中风的关联结果相似，但社会压力仅与缺血性中风相关。
较高的SLE和社会压力与较高的CVD发病率相关，独立于社会人口学因素和抑郁症状，但并非独立于行为和生物学风险因素。
