Accumulation of psychosocial risk factors and incidence of cardiovascular disease: a prospective observation of the Polish HAPIEE cohort

Abstract

Background: Psychosocial risk factors for cardiovascular disease (CVD) are known to cluster in individuals, but the effect of cumulative exposure has not been thoroughly described in terms of CVD risk.

Aims: The aim of the study was to assess the relationship between accumulation of psychosocial risk factors such as low education, material deprivation, depressive symptoms, and low perceived control and the risk of incident CVD.

Methods: This cohort study with 11‑year follow‑up included a random population sample (age, 45–69 years). Psychosocial factors were assessed using standard tools. Accumulation of psychosocial risk factors was determined by summing up the number of psychosocial factors experienced. The risk of incident CVD depending on the number of psychosocial factors was estimated (reference, no psychosocial factors). Cox proportional hazards models were fitted.

Results: In total, 43 572 and 51 772 person‑years were analyzed. There were 479 and 291 new CVD cases in men and women, respectively. An age‑adjusted model showed an increase in CVD risk in men exposed to 3 and 4 psychosocial risk factors by nearly 60% and 125%, respectively (P < 0.05). Further adjustment waved the association in individual strata, but a significant linear trend was observed. In women, in a fully adjusted model, the second and subsequent risk factors increased the risk of CVD by nearly 70% up to over 2‑fold (P < 0.001). The total population attributable risk associated with exposure to psychosocial risk factors in women was 34.1%.

Conclusions: The accumulation of psychosocial risk factors was associated with increased risk of CVD. In men, the relation was substantially explained by classic risk factors. In women, about one-third of incident CVD cases could be attributed to psychosocial risk factors.