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Cited by 71Cardiac Health and Mental HealthResilience and Mental HealthPhysical Activity and Health

Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age

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Bergh, Cecilia, Udumyan, Ruzan, Fall, Katja, Almroth, Henrik, Montgomery, Scott·2015·Heart
DOI 10.1136/heartjnl-2014-306703PMC PMC4396533
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Abstract

Objective: Psychosocial stress is a suggested risk for coronary heart disease (CHD). The relationship of stress resilience in adolescence with subsequent CHD risk is underinvestigated, so our objective was to assess this and investigate the possible mediating role of physical fitness. Methods: In this register-based study, 237 980 men born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semistructured interview with a psychologist. Some 10 581 diagnoses of CHD were identified. Cox regression estimated the association of stress resilience with CHD, with adjustment for established cardiovascular risk factors. Results: Low-stress resilience was associated with increased CHD risk. The association remained after adjustment for physical fitness and other potential confounding and mediating factors, with adjusted HRs (and 95% CIs) of 1.17 (1.10 to 1.25), with some evidence of mediation by physical fitness. CHD incidence rates per 1000 person-years (and 95% CIs) for low-stress, medium-stress and high-stress resilience were 2.61 (2.52 to 2.70), 1.97 (1.92 to 2.03) and 1.59 (1.53 to 1.67) respectively. Higher physical fitness was inversely associated with CHD risk; however, this was attenuated by low-stress resilience, shown by interaction testing (p<0.001). Conclusions: Low-stress resilience in adolescence was associated with increased risk of CHD in middle age and may diminish the benefit of physical fitness. This represents new evidence of the role of stress resilience in determining risk of CHD and its interrelationship with physical fitness.

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  • There are very limited, and mixed, study data results with regard to effects of resilience on cardiovascular outcomes.

    “To date, there are very limited, and mixed, study data results with regard to effects on cardiovascular outcomes. 91,92”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [91]

    The Introduction says evidence linking psychosocial stress to coronary heart disease is inconclusive, and the Discussion says few studies have examined stress resilience specifically. Those passages support limited evidence, but the paper does not describe resilience-specific cardiovascular findings as mixed; it says its findings are consistent with earlier stroke findings. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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Cited by

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Authors
Bergh, C., Udumyan, R., Fall, K., Almroth, H., & Montgomery, S.
Affiliations
  • Örebro University (SE)
  • Karolinska University Hospital (SE)
Corresponding author
Bergh, Cecilia
ORCID
Venue
Heart
Publisher
BMJ
Published
2015-03-04
Volume
101
Issue
8
Pages
623-629
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
DOI
10.1136/heartjnl-2014-306703
PMC
PMC4396533
OpenAlex
W2028549705
Cited by
71
References
5
Citations by year
2026: 4 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 7 · 2018: 8 · 2017: 15 · 2016: 5 · 2015: 4
FWCI
7.76
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Heart (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • Örebro Universitet
  • Economic and Social Research Council (RES 596-28-0001, ES/J019119/1, ES/JO19119/1)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
stress resilience, psychosocial stress, coronary artery disease, physical fitness, adolescence, middle age (human life stage), mediation, cardiovascular risk, conscription, men
MeSH terms
Adolescent, Coronary Artery Disease, Forecasting, Humans, Male, Middle Aged, Physical Fitness, Registries, Retrospective Studies, Risk Factors, Socioeconomic Factors, Stress, Psychological, Sweden, Incidence, Proportional Hazards Models, Risk Assessment, Young Adult

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