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European Heart Journal 2004 25(10):867-873; doi:10.1016/j.ehj.2004.03.003
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men

B Öhlin*, P.M Nilsson, J-Å Nilsson and G Berglund

Department of Medicine, University Hospital, S-205 02 Malmö, Sweden

* Corresponding author. Tel.: +46-40-331-000/336-819; fax: +46-40-923-272
E-mail address: bertil.ohlin{at}medforsk.mas.lu.se
E-mail address: bertil.m.ohlin{at}skane.se

Received 24 June 2003; revised 21 February 2004; accepted 4 March 2004

Abstract

Aims To prospectively investigate the association between self-reported psychosocial stress and long-term cardiovascular (CV) morbidity and mortality in a population-based cohort.

Methods and results The Malmö Preventive Project is a population-based screening and intervention programme for cardiovascular disease (CVD) risk factors. Between 1974 and 1980, a total of 13,609 (2741 women) individuals, mean age 45 years, had self-reported chronic stress determined by questionnaire. CV morbidity and mortality were followed up in national registries. Median follow-up time was 21 years.

The risk ratio (RR) for a fatal or nonfatal CV incident in the men and women of the group reporting chronic stress was 1.27 (95% CI 1.15–1.39). After stepwise adjustments for known CV risk factors, the RR was reduced to 1.14 (1.02–1.28). The highest RR was found for fatal stroke in men reporting chronic stress, 2.04 (1.07–3.88). For women alone, there was no significant increase in risk after adjustments.

Conclusion Self-reported chronic stress is an independent risk factor for CVD, particularly fatal stroke, in middle-aged men; it continues to be a risk factor after adjustment for several other known risk factors. The adjustment itself might reflect mechanisms whereby psychosocial stress directly or indirectly exerts its effects on the body, indicating a possible over-adjustment.

Key Words: Cardiovascular • Epidemiology • Mortality • Morbidity • Stress


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