Person-Centered Approach to Understanding Psychosocial Stressor Subgroups and Cardiovascular Disease: New Perspectives From the Multi-Ethnic Study of Atherosclerosis Study.

Abstract

Background: This study examined the longitudinal associations of psychosocial stress subgroups with cardiovascular disease (CVD) events and whether social support, neighborhood cohesion, and physical activity modified these associations in MESA (Multi-Ethnic Study of Atherosclerosis).

Methods and results: Data from 6349 adults (aged: 62.2 ± 10.2 years; 52.9% women) from the MESA study with no prior CVD in 2000 to 2002 (baseline) were used in this analysis. Latent class analysis was used to specify distinct psychosocial stress subgroups based on self-reported stressors stemming from respondents' neighborhood and social environment. Adjudicated CVD events (fatal and nonfatal events) were ascertained annually through the year 2019. Cox proportional hazards models were used to examine the associations between subgroup membership and CVD events. Five distinct psychosocial stress subgroups were identified via latent class analysis and were labeled "moderate neighborhood noise" (12.1%), "excessive neighborhood noise" (6.4%), "multiple high stressors" (6.3%), "high discrimination" (21.4%), and "optimal" (53.8%). By 2019, 1121 participants had experienced a CVD event. Membership in the high discrimination (hazard ratio [HR], 1.29 [95% CI, 1.10-1.51]) subgroup was associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. Neither social support, neighborhood cohesion, nor physical activity modified this association (P>0.05).

Conclusions: Distinct subgroups of individuals with high self-reported psychological distress-particularly related to discrimination and chronic stress are associated with high incident cardiovascular events.