Changes of individual perception in psychosocial stressors related to German reunification in 1989/1990 and cardiovascular risk factors and cardiovascular diseases in a population-based study in East Germany

Bohley, Stefanie; Kluttig, Alexander; Werdan, Karl; Nuding, Sebastian; Greiser, Karin Halina; Kuß, Oliver; Markus, Marcello Ricardo Paulista; Schmidt, Carsten Oliver; Völzke, Henry; Krabbe, Christine; Haerting, Johannes

doi:10.1136/bmjopen-2015-008703

Cited by 8 publications

(9 citation statements)

References 37 publications

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“…Another longitudinal German study, KORA (Cooperative Health Research in the Augsburg Region in South Germany), showed a similar prevalence of hypertension (49.2%) at baseline, but a much lower achievement of treatment targets in patients on antihypertensive pharmacotherapy (29.6% in men; 43.9% in women) [ 31 ]. The highest prevalence of hypertension was found in CARLA (the Cardiovascular Disease, Living and Ageing in Halle Study in East Germany) with 66.7% in men and 76.9% in women, which might be due to an overall older study population (mean age in women: 50.0 years; mean age in men: 61.3 years) [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Control of cardiovascular risk factors and its determinants in the general population– findings from the STAAB cohort study

Tiffe

Wagner

Rücker

et al. 2017

BMC Cardiovasc Disord

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BackgroundWhile data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD).MethodsData from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of Würzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed.ResultsBetween December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9% were female; 30.8% were physically inactive, 55.2% overweight, 19.3% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8%, 57.6%, and 3.9%, respectively. Treatment goals were not reached despite medication in 52.7% of hypertensive, in 37.3% of hyperlipidemic and in 44.0% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95%CI 1.44–2.61), higher age (OR for 30–39 years vs. 70–79 years 4.01, 95%CI 1.94–8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95%CI 1.48–3.11).ConclusionsIn the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0708-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Control of cardiovascular risk factors and its determinants in the general population– findings from the STAAB cohort study

Tiffe

Wagner

Rücker

et al. 2017

BMC Cardiovasc Disord

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“…We consider it likely that growing up in a socioeconomically disadvantaged family characterised by parental unemployment and financial hardship amplified the observed adverse metabolic health effects for those affected. We concede that having family-level information on exposure to the economic crisis would help to complete the overall picture,26 and allow us to draw inferences regarding the socioeconomic stratification of the health consequences27 of the macrolevel economic shock in postreunification East Germany. Thus, future research on the long-term metabolic health effects of exposure to an economic crisis should provide a closer examination of the role of family-level socioeconomic differences.…”

Section: Discussionmentioning

confidence: 99%

Early-life exposure to economic stress and metabolic risks in young adulthood: the children of the reunification in East Germany

Bister

Janssen

Vogt

2022

J Epidemiol Community Health

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BackgroundResearch on the long-term health consequences of early-life exposure to economic crises is scarce. We examine for the first time the long-term effects of early-life exposure to an economic crisis on metabolic health risks. We study objective health measures, and exploit the quasi-experimental situation of the postreunification economic crisis in East Germany.MethodsData were drawn from two waves of the longitudinal German Health Interview and Examination Survey for Children and Adolescents (2003–2006, 2014–2017). We compared 392 East Germans who were exposed to the economic crisis in utero and at ages 0–5 with 1123 of their West German counterparts using propensity score matching on individual and family characteristics. We assessed blood pressure, cholesterol, blood fat and body mass index (BMI); both combined as above-average metabolic health risks and individually at ages 19–30.ResultsEarly-life exposure to the economic crisis significantly increased the number of above-average metabolic health risks in young adulthood by 0.1482 (95% CI 0.0169 to 0.2796), which was 5.8% higher compared with no exposure. Among individuals exposed in utero, only females showed significant effects. Early-life exposure to the economic crisis was associated with increased systolic (0.9969, 95% CI −0.2806 to 2.2743) and diastolic blood pressure (0.6786, 95% CI −0.0802 to 1.4373), and with increased BMI (0.0245, 95% CI −0.6516 to 0.7001).ConclusionThe increased metabolic health risks found for women exposed to the postreunification economic crisis in-utero are likely attributable to increased economic stress. While the observed differences are small, they may foreshadow the emergence of greater health disparities in older age.

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“…Gallo and colleagues found that chronic stress burden in a major life domain for six months, was associated with prevalent CHD and stroke in a Hispanic population in the United States [39]. In a cohort study of Germans, a greater perceived change in stressors as a result of German reunification (worse financial, occupational and personal situation) was related to greater odds of having a self-reported CVD diagnosis in women [40]. In addition to the two cross-sectional studies, the case-control and case-crossover studies demonstrated greater odds of stressful life events prior to stroke in middle aged populations that included women [41, 42].…”

Section: Cardiovascular Disease Outcomes: Clinical Eventsmentioning

confidence: 99%

Women’s heart health at mid-life: what is the role of psychosocial stress?

Stewart

Kathawalla

Wolfe

et al. 2018

womens midlife health

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BackgroundWomen in mid-life experience unique stressors, including transitions within their family roles, informal caregiving, job stress, and perceived discrimination. The impact of these stressors on cardiovascular health in women during mid-life is of growing interest in both the popular and scientific literature. The objective of this review is to summarize the recent literature on stress and cardiovascular health in mid-life women. We focus on stressors that are relevant to mid-life women, including social stress and discrimination, and long-term risk of CVD events and subclinical CVD measures.MethodsWe systematically reviewed the literature published between January 2012 and April 2018 for studies examining stress in mid-life and either CVD endpoints or subclinical CVD outcomes. Eligible studies included at least one psychosocial stress exposure, a CVD or subclinical CVD outcome, and either included only female participants, reported sex-stratified analyses or tested for a sex*stress interaction.ResultsWe identified 37 studies published since 2012 that met our criteria and included women between the ages of 40 and 65, including 3 case-control studies, 15 cross-sectional studies, and 19 prospective cohort studies. Because clinical CVD events typically occur after age 65 in women, only 22 studies were available that evaluated stress and hard CVD events in samples with mid-life women. Results from these studies suggested an increased and significant risk of CVD due to stress. Of the 15 studies that included subclinical CVD outcomes, the majority showed that mid-life women experiencing greater levels of stress had more subclinical CVD, as indicated by carotid intima-media thickness, flow-mediated dilation and arterial stiffness; however, several studies reported null associations.ConclusionsGeneral life stress, including perceived stress and life events, in mid-life was significantly related to later-life CVD risk and mid-life subclinical CVD in the majority of studies published in the past six years. Job stress was inconsistently related to CVD risk in women, and fewer studies examined characteristics of other social roles, such as marriage, motherhood or caregiving. Perceived discrimination also was associated with CVD events and subclinical CVD in some samples of mid-life women. Further investigation into specific stressors relevant to women in mid-life, including caregiving and marital stress, are needed to understand the full extent to which life stress impacts CVD risk in mid-life women.

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Changes of individual perception in psychosocial stressors related to German reunification in 1989/1990 and cardiovascular risk factors and cardiovascular diseases in a population-based study in East Germany

Cited by 8 publications

References 37 publications

Control of cardiovascular risk factors and its determinants in the general population– findings from the STAAB cohort study

Control of cardiovascular risk factors and its determinants in the general population– findings from the STAAB cohort study

Early-life exposure to economic stress and metabolic risks in young adulthood: the children of the reunification in East Germany

Women’s heart health at mid-life: what is the role of psychosocial stress?

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