Social science & medicine (1982) · 2026
Disrupting the path to cardiovascular disease: Stress-related coping and onset of hypertension and obesity.
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Trudel-Fitzgerald Claudia, Smith Scott G, Zhang Shuqi, Kubzansky Laura D
Аннотация
OBJECTIVE: Accumulating research suggests stress-related coping contributes to cardiovascular disease risk, but its association with upstream cardiometabolic conditions remains unexplored. We examined whether coping strategies generally deemed adaptive (e.g., acceptance) and maladaptive (e.g., self-blame), as well as variability in their use (reflecting attempts to find the best strategies for managing stressors) predict risk of developing hypertension and obesity.
METHODS: Women (N = 26,126) from the Nurses' Health Study II cohort reported use of eight coping strategies in 2001. Coping variability was operationalized using a standard deviation-based algorithm and considered categorically (i.e., lower, moderate, greater levels) to assess non-linear effects. Until 2019, hypertension status was self-reported and obesity was derived from height and updated weight information. Cox regression models, controlling for baseline demographic, health-related, and behavioral factors, estimated hazard ratios (HR) and 95% confidence intervals (CI). Potential effect modification by age, menopausal status, and neighborhood socio-economic status (SES) was evaluated.
RESULTS: In the overall sample, many coping strategies were associated with increased risk of new onset obesity (e.g., per 1-SD increase in behavioral disengagement adjusting for demographic and health-related covariates: HR = 1.08, 95CI% = 1.05-1.11), but not hypertension. Greater versus lower variability levels were related to 8-10% lower risk of developing obesity and hypertension, respectively. Associations were generally comparable across age, menopausal status, and neighborhood SES subgroups.
CONCLUSIONS: Stress-related coping strategies and variability in their use were associated with risk of developing obesity and hypertension among women. Future intervention research may consider how women manage stressors to lower risk of conditions that affect lifelong cardiovascular health.
METHODS: Women (N = 26,126) from the Nurses' Health Study II cohort reported use of eight coping strategies in 2001. Coping variability was operationalized using a standard deviation-based algorithm and considered categorically (i.e., lower, moderate, greater levels) to assess non-linear effects. Until 2019, hypertension status was self-reported and obesity was derived from height and updated weight information. Cox regression models, controlling for baseline demographic, health-related, and behavioral factors, estimated hazard ratios (HR) and 95% confidence intervals (CI). Potential effect modification by age, menopausal status, and neighborhood socio-economic status (SES) was evaluated.
RESULTS: In the overall sample, many coping strategies were associated with increased risk of new onset obesity (e.g., per 1-SD increase in behavioral disengagement adjusting for demographic and health-related covariates: HR = 1.08, 95CI% = 1.05-1.11), but not hypertension. Greater versus lower variability levels were related to 8-10% lower risk of developing obesity and hypertension, respectively. Associations were generally comparable across age, menopausal status, and neighborhood SES subgroups.
CONCLUSIONS: Stress-related coping strategies and variability in their use were associated with risk of developing obesity and hypertension among women. Future intervention research may consider how women manage stressors to lower risk of conditions that affect lifelong cardiovascular health.