Meta-Analysis of Perceived Stress and Its Association With Incident Coronary Heart Disease

doi:10.1016/j.amjcard.2012.08.004

The American Journal of Cardiology

Volume 110, Issue 12, 15 December 2012, Pages 1711-1716

https://doi.org/10.1016/j.amjcard.2012.08.004 Get rights and content

Most studies examining potential associations between psychological factors and cardiovascular outcomes have focused on 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 ≥6 months. We extracted study characteristics and estimates of the risk of incident CHD associated with high perceived stress versus low perceived stress. We identified 23 potentially relevant articles, of which 6 met our criteria (n = 118,696). Included studies measured perceived stress with validated measurements and nonvalidated 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 to 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.

Section snippets

Methods

We sought to identify all studies that reported a valid estimate of the association between perceived stress and incident CHD diagnosis, hospitalization for CHD, or mortality secondary to CHD. To be included, studies must have been prospective observational cohorts that featured a self-report assessment of perceived stress on which participants could report the frequency and/or intensity of stress. Only studies that used measurements specifically referencing “stress” and not symptoms of

Results

Among 23 articles identified in our initial search, 19 required full reading after duplicate records were excluded. Of these 19, 6 met our criteria for inclusion (5 articles from the initial search6, 7, 8, 9, 10 and another article identified from the references¹¹; Figure 1).

All included studies completed recruitment and assessment of baseline characteristics from 1970 through 1990. Follow-up periods ranged from 36 to 255 months with an average of 165.9 months of follow-up (or 13.8 years).

Discussion

This is the first meta-analytic review of the association of perceived stress to incident CHD. By combining results from 6 large prospective observational cohort studies representing 118,696 participants followed for an average of >1 decade, we found that high perceived stress is associated with a risk ratio of 1.27 for incident CHD. It is useful to compare the magnitude of the increased risk associated with high perceived stress to those of traditional cardiovascular risk factors. For

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: This work was supported by Grants HL-088117 and CA-156709 from the National Institutes of Health, Bethesda, Maryland and in part by CTSA Grant UL1RR024156 from Columbia University, New York, New York.

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Coronary artery diseaseMeta-Analysis of Perceived Stress and Its Association With Incident Coronary Heart Disease

Section snippets

Methods

Results

Discussion

Public Health

Am J Cardiol

Pain

J Clin Epidemiol

Lancet

Lancet

J Psychosom Res

Metabolism

A path model of chronic stress, the metabolic syndrome, and coronary heart disease

Psychosom Med

Psychological distress, physical illness, and risk of coronary heart disease

J Epidemiol Community Health

Work-related psychosocial factors and the development of ischemic heart disease: a systematic review

Cardiol Rev

Marital status, marital strain, and risk of coronary heart disease or total mortality: the Framingham Offspring Study

Psychosom Med

Perceived mental stress and mortality from cardiovascular disease among Japanese men and women: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk sponsored by Monbusho (JACC study)

Circulation

Coronary artery disease
Meta-Analysis of Perceived Stress and Its Association With Incident Coronary Heart Disease