{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:09:58Z","timestamp":1788876598185,"version":"build-2803163510"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Most data linking chronic stress with cardiovascular disease (CVD) risk factors and outcomes have focused on single\u2010domain stress measurements. We evaluated the association between a novel composite measure of chronic perceived stress and CVD risk factors and outcomes in a diverse population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Individual chronic stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated to create a novel composite stress score (CSS). Participants from the DHS (Dallas Heart Study) phase 2 (2007\u20132009) visit without prevalent CVD who completed chronic stress questionnaires were included (n=2685). Associations between CSS and demographics, cardiac risk factors, and health behaviors were assessed in multivariable analyses. Cox proportional hazards models adjusting for traditional risk factors were used to determine associations of the CSS with adjudicated atherosclerotic CVD and global CVD (atherosclerotic CVD, heart failure, and atrial fibrillation) outcomes. CSS was higher among participants who were younger, women, and Black or Hispanic individuals, with lower income and educational attainment (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.0001 for each). In multivariable regression models adjusting for age, sex, race and ethnicity, income and education, higher CSS associated with hypertension, smoking, higher body mass index, hemoglobin A\n                      <jats:sub>1C<\/jats:sub>\n                      , high\u2010sensitivity C\u2010reactive protein, and sedentary time (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.01 for each). Over a median follow\u2010up of 12.4\u2009years, higher CSS associated with atherosclerotic CVD (adjusted hazard ratio [HR]. 1.22 per SD [95% CI, 1.01\u20131.47]) and global CVD (adjusted HR, 1.20 [95% CI, 1.03\u20131.40]). No interactions were seen between CSS, demographic factors, and outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Composite measures of chronic stress are higher in vulnerable populations and may help identify individuals at risk for CVD who may benefit from enhanced prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.033752","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T06:33:51Z","timestamp":1739946831000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Associations of a Composite Stress Measurement Tool With Cardiovascular Risk Factors and Outcomes: Findings From the Dallas Heart Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1838-9849","authenticated-orcid":false,"given":"Ijeoma","family":"Eleazu","sequence":"first","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2060-2263","authenticated-orcid":false,"given":"Colby","family":"Ayers","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6197-9860","authenticated-orcid":false,"given":"Ann Marie","family":"Navar","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9178-3578","authenticated-orcid":false,"given":"Karim","family":"Salhadar","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Albert","sequence":"additional","affiliation":[{"name":"University of California, San Francisco Medical Center","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7035-0848","authenticated-orcid":false,"given":"Mercedes","family":"Carnethon","sequence":"additional","affiliation":[{"name":"Northwestern University","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Sherwood","family":"Brown","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Ogbu Nwobodo","sequence":"additional","affiliation":[{"name":"University of California, San Francisco Medical Center","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer","family":"Carter","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9173-4250","authenticated-orcid":false,"given":"Courtney","family":"Bess","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9488-4131","authenticated-orcid":false,"given":"Tiffany M.","family":"Powell\u2010Wiley","sequence":"additional","affiliation":[{"name":"National Institutes of Health","place":["Bethesda, USA"]},{"name":"National Institutes of Health","place":["Bethesda, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-7261","authenticated-orcid":false,"given":"James A.","family":"de Lemos","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17019-0"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.08.004"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2009.02124.x"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e3180f62357"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0749-3797(97)00018-4"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199502000-00007"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e3182a893ae"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000019"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000447"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.09.022"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf207"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/oby.20012"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.061763"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.004815"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000028145.58654.41"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht216"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.03.003"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2017.06.012"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.02.058"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.05.043"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.027272"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.2307\/2136404"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1080\/02770900701344165"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199401000-00004"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199102000-00008"},{"key":"e_1_3_2_28_2","first-page":"1","article-title":"National health and nutrition examination survey: plan and operations, 1999\u20132010","volume":"1","author":"Zipf G","year":"2013","unstructured":"Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J. National health and nutrition examination survey: plan and operations, 1999\u20132010. Vital Health Stat. 2013;1:1\u201337.","journal-title":"Vital Health Stat"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.043628"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.003959"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001280"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029493"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31714-7"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/MOL.0000000000000457"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.599341"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2015.08.007"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.07.069"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2009.09.017"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1042\/Cs20220304"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-075847"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/Circulationaha.110.010710"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269215510380825"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.4278\/ajhp.121009-QUAN-492"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-1174"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002243"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.185652"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.033752","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:38:32Z","timestamp":1788874712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.033752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":45,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,3,4]]}},"alternative-id":["10.1161\/JAHA.123.033752"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.033752","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"assertion":[{"value":"2023-11-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e033752"}}