Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age

Bergh, Cecilia; Udumyan, Ruzan; Fall, Katja; Almroth, Henrik; Montgomery, Scott

doi:10.1136/heartjnl-2014-306703

Cited by 63 publications

(58 citation statements)

References 31 publications

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“…5 A Swedish study of 237 980 military conscripts (a subset of the present study cohort) found that low stress resilience was associated with a modestly increased risk of coronary heart disease, but did not examine hypertension or other risk factors for heart disease. 12 High BMI and type 2 diabetes were the strongest risk factors for hypertension in the present study. The ∼2.5-fold risk of hypertension that we observed among overweight or obese males is consistent with previously reported estimates for adult men or women.…”

Section: Discussionsupporting

confidence: 55%

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Low stress resilience in late adolescence and risk of hypertension in adulthood

Crump

Sundquist

Winkleby

et al. 2016

Heart

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Objective Greater blood pressure reactivity to psychological stress has been associated with higher risk of developing hypertension. We hypothesised that low stress resilience based on psychological assessment early in life is associated with hypertension in adulthood. Methods National cohort study of 1 547 182 military conscripts in Sweden during 1969–1997 (97–98% of all 18-year-old males) without prior history of hypertension, who underwent standardised psychological assessment by trained psychologists for stress resilience (1–9 scale), and were followed up for hypertension identified from outpatient and inpatient diagnoses during 1969–2012 (maximum age 62). Results 93 028 men were diagnosed with hypertension in 39.4 million person-years of follow-up. Adjusting for body mass index (BMI), family history and socioeconomic factors, low stress resilience at age 18 was associated with increased risk of hypertension in adulthood (lowest vs highest quintile: HR 1.43; 95% CI 1.40 to 1.46; p<0.001; incidence rates, 278.7 vs 180.0 per 100 000 person-years), including a strong linear trend across the full range of stress resilience (ptrend<0.0001). We also found a positive additive interaction between stress resilience and BMI (p<0.001), indicating that low stress resilience accounted for more hypertension cases among those with high BMI. Men with a combination of low stress resilience and high BMI had a more than threefold risk of hypertension. Conclusions These findings suggest that low stress resilience may contribute to etiological pathways for hypertension and accounts for more cases among those with high BMI. If confirmed, this knowledge may help inform better preventive interventions by addressing psychosocial risk factors and stress management across the lifespan.

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Section: Discussionsupporting

confidence: 55%

“…11 These data have previously been used to examine stress resilience in relation to other outcomes, including coronary heart disease. 12 …”

Section: Stress Resilience Ascertainmentmentioning

confidence: 99%

Low stress resilience in late adolescence and risk of hypertension in adulthood

Crump

Sundquist

Winkleby

et al. 2016

Heart

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“…Other studies have reported that general emotional stress [5], feelings of anger [6], hostility [7], and anxiety or depression [8, 9] are risk factors for type 2 diabetes. A Swedish study of 237,980 military conscripts (a subset of the present study cohort) found that low stress resilience was associated with a modestly increased risk of coronary heart disease, but did not examine diabetes or other risk factors for heart disease [16]. …”

Section: Discussionmentioning

confidence: 99%

“…A validation study in which 30 recorded interviews from 1972-1973 were scored by 30 psychologists reported high interrater reliability (correlation 0.86) [15]. Low stress resilience using these data has previously been examined in relation to other outcomes, including coronary heart disease [16], stroke [17] and peptic ulcer disease [18]. …”

Section: Methodsmentioning

confidence: 99%

Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men

et al. 2016

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Aims/hypothesis Psychosocial stress in adulthood is associated with a higher risk of type 2 diabetes, possibly mediated by behavioural and physiological factors. However, it is unknown whether low stress resilience earlier in life is related to subsequent development of type 2 diabetes. We examined whether low stress resilience in late adolescence is associated with an increased risk of type 2 diabetes in adulthood. Methods We conducted a national cohort study of all 1,534,425 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old men nationwide each year) without prior diagnosis of diabetes, who underwent standardised psychological assessment for stress resilience (on a scale of 1-9) and were followed up for type 2 diabetes identified from outpatient and inpatient diagnoses during 1987-2012 (maximum attained age 62 years). Results There were 34,008 men diagnosed with type 2 diabetes in 39.4 million person-years of follow-up. Low stress resilience was associated with an increased risk of developing type 2 diabetes after adjusting for BMI, family history of diabetes, and individual and neighbourhood socioeconomic factors (HR for lowest vs highest quintile: 1.51; 95% CI 1.46, 1.57; p<0.0001), including a strong linear trend across the full range of stress resilience (ptrend<0.0001). This association did not vary by BMI level, family history of diabetes or socioeconomic factors. Conclusions/interpretation These findings suggest that low stress resilience may play an important long-term role in aetiological pathways for type 2 diabetes. Further elucidation of the underlying causal factors may help inform more effective preventive interventions across the lifespan.

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“…Large longitudinal register-based studies have linked low stress resilience in late adolescence with subsequent increased risk of coronary heart disease,6 ischaemic and haemorrhagic stroke,7 hypertension,8 heart failure9 and diabetes mellitus type 210 as well as with liver cancer and lung cancer 11. Stress-induced unfavourable health behaviours have been proposed as a main pathway in these associations, and evidence from cross-sectional studies have indicated that higher stress resilience may mitigate tendencies for smoking, nicotine dependence, life-time alcohol consumption and illicit drug use 12–15.…”

Section: Introductionmentioning

confidence: 99%

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

Kennedy

Chen

Fang

et al. 2019

J Epidemiol Community Health

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BackgroundWhile compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.MethodsIn this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.ResultsWe found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.ConclusionLow stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

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Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age

Cited by 63 publications

References 31 publications

Low stress resilience in late adolescence and risk of hypertension in adulthood

Low stress resilience in late adolescence and risk of hypertension in adulthood

Stress resilience and subsequent risk of type 2 diabetes in 1.5 million young men

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

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