Associations of emotional social support, depressive symptoms, chronic stress, and anxiety with hard cardiovascular disease events in the United States: the multi-ethnic study of atherosclerosis (MESA)

Abstract

Background: Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality around the globe and psychosocial factors are not sufficiently understood. Aim: In the current study, we aimed to evaluate the role of different psychosocial factors including depressive symptoms, chronic stress, anxiety, and emotional social support (ESS) on the incidence of hard CVD (HCVD). Methods: We examined the association of psychosocial factors and HCVD incidence amongst 6,779 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Using physician reviewers’ adjudication of CVD events incident, depressive symptoms, chronic stress, anxiety, emotional social support scores were measured by validated scales. We used Cox proportional Hazards (PH) models with psychosocial factors in several of the following approaches: (1) Continuous; (2) categorical; and (3) spline approach. No violation of the PH was found. The model with the lowest AIC value was chosen. Results: Over an 8.46-year median follow-up period, 370 participants experienced HCVD. There was not a statistically significant association between anxiety and HCVD (95%CI) for the highest versus the lowest category [HR = 1.51 (0.80–2.86)]. Each one point higher score for chronic stress (HR, 1.18; 95% CI, 1.08–1.29) and depressive symptoms (HR, 1.02; 95% CI, 1.01–1.03) was associated with a higher risk of HCVD in separate models. In contrary, emotional social support (HR, 0.98; 95% CI, 0.96–0.99) was linked with a lower risk of HCVD. Conclusions: Higher levels of chronic stress is associated with greater risk of incident HCVD whereas ESS has a protective association.