Stressful life events tied to heart disease in older black women

Stressful life events were linked to higher incidents of heart attack, stroke and other types of cardiovascular disease in African-American women, according to new research that also looked at whether a person's resilience could help ward off the impact of stress.

The study did not find a connection between resilience and cardiovascular disease, but its authors encouraged more research into that area and other potential links.

"Stress may be particularly relevant for African-American women, given the discriminatory environment in which these women may live. However, research on the relationship between stress and CVD (cardiovascular disease) among African-American women is sparse," said the authors of an Ohio State University-led study published Tuesday in the American Heart Association's journal Circulation: Cardiovascular Quality and Outcomes.

Among 10,785 African-American postmenopausal women who were followed over an average of 12.5 years, those who experienced significant life events – such as the death of a spouse or close friend, getting divorced, abuse, losing a job, or having major financial problems – were more likely to have a cardiovascular event. Angina was the most common, followed by stroke, heart disease and congestive heart failure.

Women who experienced stressful events had a higher risk of cardiovascular events at ages 55 and 65. But that same kind of stress was less likely to affect their cardiovascular disease risk as these women got older.

In addition, the connection between stress and cardiovascular events lessened after adjusting for traditional risk factors such as high blood pressure, diabetes, high cholesterol, diabetes and lack of physical activity.

"Stress might play a role in developing cardiovascular disease, but what's even more important are the conventional risk factors that we already know about," said Ashley Felix, the study's lead author and an assistant professor of epidemiology at Ohio State University's College of Public Health in Columbus.

"So, in thinking about prevention of cardiovascular disease, it's never too early and it's never too late to start eating right, exercising and quitting smoking because those are really the interventions that will make a meaningful impact in reducing cardiovascular disease risk."

Researchers also explored the role of resilience, or the ability to bounce back from adversity.

Resilience wasn't found to offset the association between stress and cardiovascular events, but Felix said that's probably more a reflection of how it was assessed, particularly among African-American women.

That's not surprising given how complicated resilience can be to measure, said Dr. Michelle Albert, a professor of medicine at the University of California at San Francisco and author of an editorial that accompanied the study.

"There are no great resilience scales. None of them can really capture even just a blush of resilience," said Albert, director of UCSF's Center for the Study of Adversity and Cardiovascular Disease.

Albert commended the study for both the way it looked at experiences over a stretch of time and for focusing only on African-American women.

"There's usually a comparison between whites and blacks, or blacks and somebody else. It's not usually where just black women are looked at, and that's very commendable on the part of the authors," she said.

Researchers called it "unfortunate" that few studies have investigated the link between stress and cardiovascular disease in large groups of African-American women, especially since this population is disproportionately affected by psychosocial challenges including limited access to health care, lower median household incomes, less access to healthy food choices, and higher exposure to crime when compared to white women.

Albert said looking at race-related connections are key to "getting to the bottom of the issue, in part because black women, among all women, have some of the worst outcomes in cardiovascular disease and are often shuffled aside under the rubric of 'women.'"

"It's really important they looked only among black women," Albert said. "In general, the whole concept of black women's race or ethnicity is usually very much minimized."