Meta-Analysis of Perceived Stress and Its Association With Incident Coronary Heart Disease
Open accessAbstract
Most studies examining potential associations between psychological factors and cardiovascular outcomes have focused on either depression or anxiety. The effect of perceived stress on incident coronary heart disease (CHD) has yet to be reviewed systematically. We conducted a systematic review and meta-analysis of the association between perceived stress and incident CHD. Ovid MEDLINE and PsycINFO were searched as data sources. Prospective observational cohort studies were selected that measured self-reported perceived stress and assessed incident CHD at minimum of 6 months later. We extracted study characteristics and estimates of the risk of incident CHD associated with high perceived stress vs. low perceived stress. We identified 23 potentially relevant articles, of which 6 met our criteria (N = 118,696). Included studies measured perceived stress with both validated measures and non-validated simple self-report surveys. Incident CHD was defined as new diagnosis of, hospitalization for, or mortality secondary to CHD. Meta-analysis yielded an aggregate risk ratio of 1.27 (95% confidence interval 1.12 – 1.45) for the magnitude of the relation between high perceived stress and incident CHD. In conclusion this meta-analysis suggests that high perceived stress is associated with a moderately increased risk of incident CHD.
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High perceived stress is associated with a 27% increased risk in incident CHD and CHD mortality (RR, 1.27 [95% CI, 1.12-1.45]).
“Another meta-analysis that focused on patient reports of perceived stress, regardless of cause, and included data from 118 696 participants across 6 studies found that high perceived stress was associated with a 27% increased risk in incident coronary heart disease (CHD) and CHD mortality (RR, 1.27 [95% CI, 1.12-1.45]). 19”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [19]
Small clinical trials evaluating a gratitude intervention suggested improvements in blood pressure, sleep, inflammatory biomarkers, and heart rate variability.
“Small clinical trials evaluating a gratitude intervention (eg, gratitude journaling) suggested improvements in blood pressure, sleep, inflammatory biomarkers, and heart rate variability. 19,20”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [19]
The Discussion (page not supplied) mentions trials of stress-reduction interventions such as cognitive behavioral therapy, yoga, and muscle relaxation, but not gratitude interventions. Searches for gratitude journaling, sleep, inflammatory biomarkers, and heart rate variability found no passage reporting the claimed trial outcomes. (LLM, conf=0.76)
Experimental — accuracy not yet measuredOccupational stress is a major risk factor for depression, coronary disease and related mortality.
“Occupational stress has shown to be a major risk factor for a range of health outcomes, such as depression [1], coronary disease ( [2] and related mortality [3].”
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Self-citation
- Authors
- Richardson, S., Shaffer, J. A., Falzon, L., Krupka, D., Davidson, K. W., & Edmondson, D.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Edmondson, Donald
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 110
- Issue
- 12
- Pages
- 1711-1716
- ISSN
- 0002-9149 (ISSN-L)
- PMC
- PMC3511594
- OpenAlex
- W2125315255
- Semantic Scholar
- 071040f82c0994a6069523d431dae51245242878
- Cited by
- 349
- References
- 28
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 31 · 2023: 28 · 2022: 52 · 2021: 29 · 2020: 18 · 2019: 29 · 2018: 21 · 2017: 25 · 2016: 19 · 2015: 25 · 2014: 17 · 2013: 10
- FWCI
- 2.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institutes of Health (UL1RR024156)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- perceived stress, coronary artery disease, incident coronary heart disease, psychological stress, cardiovascular risk, self-reported stress, relative risk
- MeSH terms
- Coronary Disease, Humans, Perception, Risk Factors, Stress, Psychological
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