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Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-3649-2639
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
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2015 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 101, no 8, 623-629 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Psychosocial stress is a suggested risk for coronary heart disease (CHD). The relationship of stress resilience in adolescence with subsequent CHD risk is underinvestigated, so our objective was to assess this and investigate the possible mediating role of physical fitness.

METHODS: In this register-based study, 237 980 men born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semistructured interview with a psychologist. Some 10 581 diagnoses of CHD were identified. Cox regression estimated the association of stress resilience with CHD, with adjustment for established cardiovascular risk factors.

RESULTS: Low-stress resilience was associated with increased CHD risk. The association remained after adjustment for physical fitness and other potential confounding and mediating factors, with adjusted HRs (and 95% CIs) of 1.17 (1.10 to 1.25), with some evidence of mediation by physical fitness. CHD incidence rates per 1000 person-years (and 95% CIs) for low-stress, medium-stress and high-stress resilience were 2.61 (2.52 to 2.70), 1.97 (1.92 to 2.03) and 1.59 (1.53 to 1.67) respectively. Higher physical fitness was inversely associated with CHD risk; however, this was attenuated by low-stress resilience, shown by interaction testing (p<0.001).

CONCLUSIONS: Low-stress resilience in adolescence was associated with increased risk of CHD in middle age and may diminish the benefit of physical fitness. This represents new evidence of the role of stress resilience in determining risk of CHD and its interrelationship with physical fitness.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2015. Vol. 101, no 8, 623-629 p.
National Category
Cardiac and Cardiovascular Systems
Research subject
Epidemiology; Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-43425DOI: 10.1136/heartjnl-2014-306703ISI: 000351755300009PubMedID: 25740818Scopus ID: 2-s2.0-84927665875OAI: oai:DiVA.org:oru-43425DiVA: diva2:793466
Note

Funding Agencies:

UK Economic and Social Research Council (ESRC) RES-596-28-0001  ES/JO19119/1

Stiftelsen Olle Engqvist Byggmästare, Folksam

Örebro University

Available from: 2015-03-06 Created: 2015-03-06 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Life-course influences on occurrence and outcome for stroke and coronary heart disease
Open this publication in new window or tab >>Life-course influences on occurrence and outcome for stroke and coronary heart disease
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 156
Keyword
cardiovascular disease, stroke, risk factors, adolescence, stress resilience, adult infections, life-course epidemiology, cohort study
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-54254 (URN)978-91-7529-177-2 (ISBN)
Public defence
2017-03-10, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2017-01-03 Created: 2017-01-03 Last updated: 2017-10-18Bibliographically approved

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