1197Perceived stress and ideal cardiovascular health: the Paris Prospective Study III

Abstract

Background: Despite the demonstrated benefit of ideal cardiovascular health (CVH) on health related outcomes, the prevalence of ideal CVH remains low in the population. Psychological factors may contribute to this gap in ideal cardiovascular health. Purpose:We hypothesized that subjects with high level of perceived stress would be less frequently in ideal cardiovascular health (CVH). Methods: Between June 2008 and May 2012, 10157 subjects from the community were examined in a large health preventive center in Paris and were volunteers for participating in the Paris Prospective Study III. CVH was estimated by the 7-item tool developed by the American Heart Association (AHA) including 4 health behaviors (smoking, body mass index, physical activity and diet) and 3 biological factors (blood pressure, total cholesterol and fasting glycaemia) Each metric was categorized as poor, intermediate or ideal CVH and weighted as 0, 1 or 2 respectively. Global, behavioral and biological CVH scores were obtained by summing each weight. Perceived stress was measured with the validated 4-item Perceived Stress Scale at baseline and after 4 years of follow-up. The bi-directional association between CVH and perceived stress was explored in linear and polytomous logistic regression analysis. Results: 9953 participants (61% men) free of personal cardiovascular history and aged 59.63 years on average were finally included. At baseline, there was an inverse significant association between the level of perceived stress (exposure) and global CVH score (highest vs. lowest quartile of stress: β: -0.23, p<0.001). This association was still significant after adjustment for sex, age, education, depression and deprivation. The association existed for behavioral CVH score (highest vs. lowest quartile of stress: β: -0.30, p<0.0001) but not for the biological CVH score (highest vs. lowest quartile of stress: β: 0.056, p=0.108). On the other hand, there was an inverse significant association between global CVH score (exposure) and the level of perceived stress (OR for being in the highest vs. the lowest quartile of stress per unit increase in the score: 0.95; IC95% [0.92; 0.98]), which was still significant after multivariate adjustment. The association existed for the behavioral score (OR 0.89 IC95% [0.85; 0.92]) but not for the biological score (OR 1.04 IC95% [0.99; 1.08]). In multivariate longitudinal analysis, baseline global and behavioral CVH scores (exposure) but not biological score were inversely associated with perceived stress score at 4 years of follow-up (β for 1 point increase in global score: -0.04, p=0.02; β for 1 point increment in behavioral CVH score: -0.12, p<0.001). Conclusion: Our data demonstrate a bi-directional association between perceived stress and cardiovascular health status, in particular behavioral cardiovascular health, which has implications for prevention.