A path model of chronic stress, the metabolic syndrome, and coronary heart disease

  • Vitaliano P
  • Scanlan J
  • Zhang J
 et al. 
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Objective: We tested a theoretical stress model cross-sectionally and
prospectively that examined whether relationships of chronic stress,
psychophysiology, and coronary heart disease (CHD) varied in older adult
men (N = 47), older adult women not using hormone replacement therapy
(HRT) (N = 64), and older adult women using HRT (N = 41). Method:
Structural equations examined relationships of CHD with 1) chronic
stress (caring for a spouse with Alzheimer's disease and patient
functioning), 2) vulnerability (anger and hostility), 3) social
resources (supports), 4) psychological distress (burden, sleep problems,
and low uplifts), 5) poor health habits (high-caloric, high-fat diet and
limited exercise), and 6) the metabolic syndrome (MS) (blood pressure,
obesity, insulin, glucose, and lipids). Results: Caregiver men had a
greater prevalence of CHD (13/24) than did noncaregiver men (6/23) (p <
.05) 27 to 30 months after study entry. This was influenced by pathways
from caregiving to distress, distress to the MS, and the MS to CHD, In
men, poor health habits predicted the MS 15 to 18 months later, and the
MS predicted new CHD cases over 27 to 30 months. In women, no
``caregiving-CHD{''} relationship occurred; however, 15 to 18 months
after study entry women not using HRT showed ``distress-MS{''} and
``MS-CHD{''} relationships. In women using HRT, associations did not
occur among distress, the MS, and CHD, but poor health habits and the MS
were related. Conclusions: In older men, pathways occurred from chronic
stress to distress to the metabolic syndrome, which in turn predicted
CHD. Older women not using HRT showed fewer pathways than men; however,
over time, distress, the MS, and CHD were related. No
psychophysiological pathways occurred in older women using HRT.

Author-supplied keywords

  • stress; coronary disease; gender; metabolic syndro

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  • P P Vitaliano

  • J M Scanlan

  • J P Zhang

  • M V Savage

  • I B Hirsch

  • I C Siegler

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