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Cited by 101Cardiac Health and Mental HealthResilience and Mental HealthHealth disparities and outcomes

Stress, Resilience, and Cardiovascular Disease Risk Among Black Women: Results From the Women’s Health Initiative

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Felix, Ashley S., Lehman, Amy, Nolan, Timiya S., Sealy-Jefferson, Shawnita, Breathett, Khadijah, Hood, Darryl B., Addison, Daniel, Anderson, Cindy M. +4 more·2019·Circulation: Cardiovascular Quality and Outcomes
DOI 10.1161/circoutcomes.118.005284PMC PMC6508630
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Abstract

Background: Empirical data on the link between stress and cardiovascular disease (CVD) risk among black women is limited. We examined associations of stressful life events and social strain with incident CVD among black women and tested for effect modification by resilience. Methods and Results: Our analysis included 10 785 black women enrolled in the Women’s Health Initiative Observational Study and Clinical Trials cohort. Participants were followed for CVD for up to 23 years (mean, 12.5). Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for associations between stress-related exposures and incident CVD. We included interactions between follow-up time (age) and stressful life events because of evidence of nonproportional hazards. Effect modification by resilience was examined in the sub-cohort of 2765 women with resilience and stressful life events measures. Higher stressful life events were associated with incident CVD at ages 55 (hazard ratio for highest versus lowest quartile=1.80; 95% CI, 1.27–2.54) and 65 (hazard ratio for highest versus lowest quartile=1.40; 95% CI, 1.16–1.68), but not at older ages. Adjustment for CVD risk factors attenuated these associations. Similar associations were observed for social strain. In the sub-cohort of women with updated stressful life events and resilience measures, higher stressful life events were associated with incident CVD in multivariable-adjusted models (hazard ratio=1.61; 95% CI, 1.04–2.51). Resilience did not modify this association nor was resilience independently associated with incident CVD. Conclusions: In this cohort of older black women, recent reports of stressful life events were related to incident CVD. Resilience was unrelated to incident CVD. Clinical Trials Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00000611.

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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 [92]

    The Discussion (page not provided) describes an evaluation of resilience in African-American women’s cardiovascular health as missing from the literature, supporting the claim that evidence is limited. The Results and Discussion report no association between resilience and incident cardiovascular disease in this cohort, but do not establish that cardiovascular-outcome findings across studies are mixed. (LLM, conf=0.83)

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Research works printed but not linked: 34

  1. [1]Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM and Gordon D. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circulation research. 2017; 120: 366– 380. 28104770 PMC5268076
  2. [2]Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH and Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007; 356: 2388– 98. 17554120
  3. [3]Decline in deaths from heart disease and stroke--United States, 1900–1999. MMWR Morbidity and mortality weekly report. 1999; 48: 649– 56. 10488780
  4. [4]Garcia M, Mulvagh SL, Merz CN, Buring JE and Manson JE. Cardiovascular Disease in Women: Clinical Perspectives. Circulation research. 2016; 118: 1273– 93. 27081110 PMC4834856
  5. [5]Jones KM, Carter MM and Schulkin J. Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists’ Knowledge, Attitudes, and Practice Patterns. Journal of racial and ethnic health disparities. 2015; 2: 256– 66. 26863341
  6. [7]Kershaw KN, Brenes GA, Charles LE, Coday M, Daviglus ML, Denburg NL, Kroenke CH, Safford MM, Savla T, Tindle HA, Tinker LF and Van Horn L. Associations of stressful life events and social strain with incident cardiovascular disease in the Women’s Health Initiative. Journal of the American Heart Association. 2014; 3: e000687. 24973226 PMC4309050
  7. [8]Ungar M. Researching and theorizing resilience across cultures and contexts. Preventive medicine. 2012; 55: 387– 9. 22884666
  8. [9]Thurston IB, Howell KH, Kamody RC, Maclin-Akinyemi C and Mandell J. Resilience as a moderator between syndemics and depression in mothers living with HIV. AIDS care. 2018: 1– 8. 29499626
  9. [10]Anderson GL, Manson J, Wallace R, Lund B, Hall D, Davis S, Shumaker S, Wang CY, Stein E and Prentice RL. Implementation of the Women’s Health Initiative study design. Ann Epidemiol. 2003; 13: S5– 17. 14575938
  10. [11]Hays J, Hunt JR, Hubbell FA, Anderson GL, Limacher M, Allen C and Rossouw JE. The Women’s Health Initiative recruitment methods and results. Ann Epidemiol. 2003; 13: S18– 77. 14575939
  11. [12]Stefanick ML, Cochrane BB, Hsia J, Barad DH, Liu JH and Johnson SR. The Women’s Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. Ann Epidemiol. 2003; 13: S78– 86. 14575940
  12. [13]Design of the Women’s Health Initiative clinical trial and observational study. The Women’s Health Initiative Study Group. Controlled clinical trials. 1998; 19: 61– 109. 9492970
  13. [14]Ruberman W, Weinblatt E, Goldberg JD and Chaudhary BS. Psychosocial influences on mortality after myocardial infarction. N Engl J Med. 1984; 311: 552– 9. 6749228
  14. [15]Rook KS. The negative side of social interaction: impact on psychological well-being. Journal of personality and social psychology. 1984; 46: 1097– 1108. 6737206
  15. [17]Heckbert SR, Kooperberg C, Safford MM, Psaty BM, Hsia J, McTiernan A, Gaziano JM, Frishman WH and Curb JD. Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the Women’s Health Initiative. Am J Epidemiol. 2004; 160: 1152– 8. 15583367
  16. [19]Everson-Rose SA and Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005; 26: 469– 500. 15760298
  17. [21]Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H and Yusuf S. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 953– 62. 15364186
  18. [23]Sumner JA, Kubzansky LD, Elkind MS, Roberts AL, Agnew-Blais J, Chen Q, Cerda M, Rexrode KM, Rich-Edwards JW, Spiegelman D, Suglia SF, Rimm EB and Koenen KC. Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women. Circulation. 2015; 132: 251– 9. 26124186 PMC4519406
  19. [24]Thomasson MA. Racial Differences in Health Insurance Coverage and Medical Expenditures in the United States: A Historical Perspective. Social Science History. 2016; 30: 529– 550.
  20. [26]Kirkpatrick SI, Dodd KW, Reedy J and Krebs-Smith SM. Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children. Journal of the Academy of Nutrition and Dietetics. 2012; 112: 624– 635.e6. 22709767 PMC3775640
  21. [27]Unger E, Diez-Roux AV, Lloyd-Jones DM, Mujahid MS, Nettleton JA, Bertoni A, Badon SE, Ning H and Allen NB. Association of neighborhood characteristics with cardiovascular health in the multi-ethnic study of atherosclerosis. Circulation Cardiovascular quality and outcomes. 2014; 7: 524– 31. 25006187 PMC4172357
  22. [28]Wyatt SB, Williams DR, Calvin R, Henderson FC, Walker ER and Winters K. Racism and cardiovascular disease in African Americans. The American journal of the medical sciences. 2003; 325: 315– 31. 12811228
  23. [29]Gebreab SY, Diez-Roux AV, Hickson DA, Boykin S, Sims M, Sarpong DF, Taylor HA and Wyatt SB. The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: the Jackson Heart Study. Social science & medicine (1982). 2012; 75: 1697– 707. 22841454 PMC3580180
  24. [31]Peters A and McEwen BS. Stress habituation, body shape and cardiovascular mortality. Neuroscience and biobehavioral reviews. 2015; 56: 139– 50. 26148986
  25. [32]McEwen BS and Stellar E. Stress and the individual. Mechanisms leading to disease. Archives of internal medicine. 1993; 153: 2093– 101. 8379800
  26. [33]Albert MA, Durazo EM, Slopen N, Zaslavsky AM, Buring JE, Silva T, Chasman D and Williams DR. Cumulative psychological stress and cardiovascular disease risk in middle aged and older women: Rationale, design, and baseline characteristics. American heart journal. 2017; 192: 1– 12. 28938955 PMC5748933
  27. [34]Taylor JY, Wright ML, Crusto CA and Sun YV. The Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) Study: Design and Methods for Complex DNA Analysis. Biological research for nursing. 2016; 18: 521– 30. 27118148 PMC5025343
  28. [35]Taylor JY, Sun YV, Barcelona de Mendoza V, Ifatunji M, Rafferty J, Fox ER, Musani SK, Sims M and Jackson JS. The combined effects of genetic risk and perceived discrimination on blood pressure among African Americans in the Jackson Heart Study. Medicine. 2017; 96: e8369. 29069027 PMC5671860
  29. [36]Bonanno GA, Westphal M and Mancini AD. Resilience to loss and potential trauma. Annual review of clinical psychology. 2011; 7: 511– 35. 21091190
  30. [37]Silverman AM, Molton IR, Alschuler KN, Ehde DM and Jensen MP. Resilience predicts functional outcomes in people aging with disability: a longitudinal investigation. Archives of physical medicine and rehabilitation. 2015; 96: 1262– 8. 25757790
  31. [38]Elliott AM, Burton CD and Hannaford PC. Resilience does matter: evidence from a 10-year cohort record linkage study. BMJ open. 2014; 4: e003917. PMC3902361 24430878
  32. [39]Ungar M, Ghazinour M and Richter J. Annual Research Review: What is resilience within the social ecology of human development? Journal of child psychology and psychiatry, and allied disciplines. 2013; 54: 348– 66. 23215898
  33. [41]Dong C, Rundek T, Wright CB, Anwar Z, Elkind MS and Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. Circulation. 2012; 125: 2975– 84. 22619283 PMC3396556
  34. [43]Kershaw KN, Diez Roux AV, Bertoni A, Carnethon MR, Everson-Rose SA and Liu K. Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis. J Epidemiol Community Health. 2015; 69: 136– 41. 25271247 PMC4806779

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Authors
Felix, A. S., Lehman, A., Nolan, T. S., Sealy-Jefferson, S., Breathett, K., Hood, D. B., Addison, D., Anderson, C. M., Cené, C. W., Warren, B. J., Jackson, R. D., & Williams, K. P.
Affiliations
  • The Ohio State University (US)
  • University of Arizona (US)
  • University of North Carolina at Chapel Hill (US)
ORCID
Venue
Circulation: Cardiovascular Quality and Outcomes
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-04
Volume
12
Issue
4
Pages
e005284-e005284
ISSN
  • 1941-7705 (ISSN-L)
  • 1941-7713
DOI
10.1161/circoutcomes.118.005284
PMC
PMC6508630
OpenAlex
W2924754900
Cited by
101
References
8
Citations by year
2026: 10 · 2025: 14 · 2024: 15 · 2023: 14 · 2022: 15 · 2021: 18 · 2020: 12 · 2019: 2
FWCI
8.49
Type
journal article
Language
en
Open access
Locations
  • Circulation Cardiovascular Quality and Outcomes (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Health and Human Services (HHSN268201600002 C, HHSN268201600018 C, HHSN268201600003C)
  • U.S. Environmental Protection Agency
  • Brigham and Women's Hospital
  • Ohio State University (K12 CA133250)
  • University of Arizona
  • MedStar Health Research Institute
  • National Institutes of Health (HHSN268201600018C, HHSN268201600003C, HHSN268201600002C, K01CA21845701A1)
  • Health Sciences, University of Arizona
  • National Heart, Lung, and Blood Institute (HHSN268201600018C, K01HL142848, HHSN268201600004C, HHSN268201600001C, HHSN268201600003C, HHSN268201600002C)
  • National Cancer Institute (HHSN268201600018C, HHSN268201600002C, HHSN268201600003C, K01CA218457, K12CA133250)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
  • Social Sciences › Health › Health disparities and outcomes
Keywords
stress, resilience, cardiovascular risk, Black women, life events, social strain, effect modification, older women, Women's Health Initiative
MeSH terms
Age Factors, Aged, Black or African American, Cardiovascular Diseases, Female, Humans, Life Change Events, Middle Aged, Prognosis, Prospective Studies, Risk Management, Social Behavior, Stress, Psychological, Time Factors, United States, Incidence, Women's Health, Risk Assessment, Resilience, Psychological

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