Cumulative psychosocial factors are associated with cardiovascular disease risk factors and management among African Americans in the Jackson Heart Study

Mario Sims,Tanya M Spruill,Samson Y Gebreab,Lá Shauntá M Glover

doi:10.1186/s12889-020-08573-0

Abstract

BackgroundRacial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects.MethodsUsing the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors.ResultsAfter full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16–1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01–1.52 and PR 1.13 95% CI 1.03–1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03–1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46–0.84).ConclusionsCumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.

Highlights

Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors
Anger-in and -out were significant for men, while only depressive symptoms and Weekly stress inventory (WSI)-events were significant for women (p < 0.05)
We found that high cynicism, anger-in and stress were associated with hypertension among men; and high depressive symptoms, stress, and Major life events (MLEs) were associated with hypertension among women

Summary

Introduction

Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. Findings from the Jackson Heart Study (JHS) reported that diabetes prevalence was 20% for women and 16% for men, while diabetes control among diabetics was greater for women [2]. While hypertension prevalence in the JHS was 65% for women and 60% for men, hypertension control was greater for women than men [3]. CVD disparities may be influenced by non-clinical risk factors, such as psychosocial factors. Psychosocial risk factors are associated with CVD development and progression in the broader population. Depression has been associated with a greater risk of becoming obese in metaanalytic studies [7]. Psychosocial stress is associated with a greater risk of hypertension [8] and a greater risk of poor diabetes control [9]

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