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Stress and cardiovascular disease risk in mid-life women: how important are social roles?

Stewart, Andrea (2018) Stress and cardiovascular disease risk in mid-life women: how important are social roles? Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: Cardiovascular disease (CVD) is the leading cause of death for women in the United States, and one of the leading causes of death globally. Recent declines in mortality rates have been limited to men and older adults, while the rates for middle aged women have been slower to decline. The mid-life, between the ages of 40 and 65, is a crucial time for studying the development of risk factors for CVD in women. Social roles are important factors that can determine health behaviors, and the stress that women derive from these roles can influence their CVD risk.
Aims: This dissertation has three aims. First, we systematically reviewed the recent literature of stress and CVD in mid-life women. Second, we used data from the Study of Women’s Health Across the Nation (SWAN) to study the relationship between stress and reward from four social roles in mid-life and established CVD risk factors, including fasting glucose, cholesterol, blood pressure, body mass index (BMI), physical activity, diet and smoking. Third, we determined if social role stress and reward in mid-life are related to subclinical CVD markers in later-life.
Results: We identified a consistent relationship between stress and CVD events and subclinical CVD in recent high-quality studies in mid-life women. In SWAN, mid-life social role-related stress was related to lower odds of having ideal levels of glucose and blood pressure, having a BMI less than 30, and any components of a healthy diet. Having a stressful social role in mid-life was also related to greater carotid intima-media thickness (a marker of subclinical CVD) later in SWAN. Other markers of subclinical CVD were unrelated to social role-related stress and reward.
Conclusion: This dissertation demonstrates strong evidence that social roles are important for CVD risk and risk factors in middle aged women. These findings have public health significance because of their implications for designing novel interventions for widespread established risk factors for a leading cause of mortality in the United States, in a population that has seen fewer recent gains in mortality reduction.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Stewart, Andreaals329@pitt.eduals329
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrooks,
Committee MemberBarinas-Mitchell,
Committee MemberMagnani,
Committee MemberMatthews,
Date: 26 September 2018
Date Type: Publication
Defense Date: 25 July 2018
Approval Date: 26 September 2018
Submission Date: 19 July 2018
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 143
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: cardiovascular disease, epidemiology, women's health, stress, social roles, heart disease, risk factors, atherosclerosis
Date Deposited: 26 Sep 2018 15:05
Last Modified: 01 Sep 2021 05:15


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