Stress-related conditions are “robustly” linked to CVD

  • Song H & al.
  • BMJ
  • 10 Apr 2019

  • International Clinical Digest
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Takeaway

  • Stress-related disorders show a “robust” and independent association with cardiovascular diseases (CVDs), especially with CVD onset before age 50 years.

Why this matters

  • This study uses sibling comparisons.
  • Editorial notes the potential for reverse causation, with existing CVD entailing proneness to stress disorders, but observes that findings with heart failure argue against reverse causation.

Key results

  • HR for CVD in
  • HR for ≥1 year: 1.28 (1.24-1.34).
  • HRs for specific CVDs with stress-related disorder:
    • Heart failure within first year of stress disorder diagnosis: 6.95 (1.88-25.68).
    • Arrhythmia after 1 year: 1.12 (1.04-1.21).
    • Arterial thromboembolism after 1 year: 2.02 (1.45-2.82).
  • Strongest associations with early onset (
  • Risk peaked just after stress disorder diagnosis.

Study design

  • Population-based, sibling-controlled cohort study; 136,637 patients from Swedish registry, all diagnosed with stress-related conditions.
  • Compared with 171,314 unaffected full siblings and 1,366,370 from the general population.
  • Median follow-ups for patients, siblings, general population: 6.2, 6.9, and 6.5 years, respectively.
  • Funding: Icelandic Research Fund; Karolinska Institute; others.

Limitations

  • Primary care information lacking.
  • Siblings also could have experienced the stress but had undiagnosed stress disorders.

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