Cardiovascular
Racial and sex disparities in the association between stressful life events and cardiovascular disease Ugochinyere Vivian Ukah* Ugochinyere Vivian Ukah Nkasiobi Nwobi
Background: Racial disparities exist in the incidence of cardiovascular disease (CVD) with black women having a higher risk of CVD, compared with other racial groups. Stressful life event (SLE) is a risk factor for cardiovascular disease CVD. However, whether racial and sex difference exist in the relationship between SLEs and CVD risk is understudied.
Methods: We analyzed the US Go dataset, which integrates three harmonized cohorts of participants from the United States enrolled between 1948 and 2002: the Multi-Ethnic Study of Atherosclerosis (MESA), the Cardiovascular Health Study (CHS), and the Women’s Health Initiative (WHI). SLEs were derived from study-specific questionnaires that captured the occurrence of traumatic events in the past year, such as the death of a loved one, divorce, and financial difficulties. We analyzed SLEs as a continuous stress variable, with a range of 0–1. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SLEs and incident CVD or CVD-related mortality, adjusting for confounders. Participants were then stratified by race (White, Black) and sex (male, female).
Results: A total of 82,721 participants were included. The overall mean stress level was higher among Black participants (0.21 ± 0.18) compared to White participants (0.15 ± 0.13). SLEs were associated with an increased risk of CVD (HR 1.95, 95%CI 1.70–2.23). The association was similar across racial groups, with HRs of 1.88 (95%CI 1.39–2.54) for Black participants and 1.86 (95% CI 1.59–2.17) for White participants. Among females, SLEs were strongly associated with CVD risk (HR 2.35, 95%CI 2.01–2.75), and for both Black HR: 2.27 (1.56–3.31) and White (HR 2.14, 95%CI 1.80–2.54) females. In contrast, no associations were found among males (HR 1.13, 95%CI 0.86–1.50).
Conclusions: In our study, Black individuals were more likely to experience higher SLEs compared to White individuals and the risk of CVD was higher among females experiencing more SLEs. Our findings suggest that race and sex may contribute to a disproportionate risk of cardiovascular CVD among Black populations.