Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries

作者：Ailiana Santosa, Annika Rosengren, Chinthanie Ramasundarahettige, Sumathy Rangarajan, Sadi Güleç, Jephat Chifamba, Scott A. Lear, Paul Poirier, Karen Yeates, Rita Yusuf, Andreas Orlandini, Liu Weida, Sidong Li, Zhu Yibing, Viswanathan Mohan, Manmeet Kaur, Katarzyna Zatońska, Noor Hassim Ismail, Patricio López‐Jaramillo, Romaina Iqbal, Lia M. Palileo‐Villanueva, Afzalhussein Yusufali, Khalid F. AlHabib, Salim Yusuf · 发表于：JAMA Network Open · 年份：2021 · DOI：10.1001/jamanetworkopen.2021.38920 · 被引用次数：143 · 研究领域：Stress Responses and Cortisol、Cardiac Health and Mental Health、Cardiovascular Health and Risk Factors

Importance: Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. Objective: To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. Design, Setting, and Participants: This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. Exposures: All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. Main Outcomes and Measures: The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. Results: A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, ...