Chronic Stress and Cardiovascular Health: The MESA and MASALA Studies

Saaniya Farhan, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Laura A. Colangelo, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abigail Marie Gauen, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Nilay S. Shah, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Alka M. Kanaya, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC.
Kiarri N. Kershaw, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Michael P. Bancks, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC.
Sameera Talegawkar, Department of Exercise and Nutrition Sciences, George Washington University School of Public Health, Washington, DC.
Luis A. Rodriguez, Division of Research, Kaiser Permanente Northern California, Pleasanton, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA.
Donald M. Lloyd-Jones, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Norrina B. Allen, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Rachel Zmora, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: rachel.zmora@northwestern.edu.

Document Type

Journal Article

Publication Date

8-12-2025

Journal

American journal of preventive medicine

DOI

10.1016/j.amepre.2025.108045

Keywords

Cardiovascular health; Chronic Stress; health disparities

Abstract

INTRODUCTION: Research suggests chronic stress is associated with individual cardiovascular health (CVH) metrics (e.g., physical activity and diet quality); however, the association between chronic stress and overall CVH is less well understood. Further, minoritized racial and ethnic groups experience a disproportionate stress burden. Therefore, this study assessed the association between chronic stress and CVH within two racially and ethnically diverse cohorts. METHODS: This study utilized pooled data from 7978 participants of the Multi-Ethnic Study of Atherosclerosis (MESA) and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) studies collected between 2000-2011 and 2010-2018, respectively. The associations between chronic stress and the cross-sectional and annualized change in Life's Essential Eight CVH score, excluding sleep, (range 0-100), were assessed using linear regression to adjust for sociodemographic factors. Anxiety, depression, and social support were assessed as potential moderators of this association. Analyses were repeated using individual CVH metrics as the outcome. Analyses were conducted in 2025. RESULTS: In cross-sectional analyses, individuals with high chronic stress had a 2.7-point lower (-2.71, 95% CI = -3.46, -1.95) CVH score compared to individuals with no chronic stress after adjustment. No association between chronic stress and annualized change in CVH score was observed. Additionally, there was no moderation by anxiety, depression, or social support. CONCLUSIONS: Elevated chronic stress is adversely associated with concurrent CVH. These results highlight the important relationship between chronic stress and health.

Department

Exercise and Nutrition Sciences

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