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Stressful life events and augmentation index: results from the Cardiovascular and Metabolic Diseases Etiology Research Center


Several studies have reported a positive association between psychological stress and cardiovascular diseases; however, there is scarce evidence about various aspects of life stress, including traumatic, positive, and negative events. We aimed to evaluate the association between various stressful life events and indicators of cardiovascular risk, including the augmentation index. A total of 3276 participants from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort (Mean age: 50.9) were analyzed cross-sectionally. By using the Life Experience Questionnaire, exposures were grouped as a “positive event,” “negative event,” or “traumatic event.” The augmentation index and subclinical atherosclerosis were measured. Multivariate polytomous logistic regression was used. Overall, stressful life events did not show any significant association with any cardiovascular index; however, increased odds ratios were observed between augmentation index quartiles and those who had experienced traumatic events (quartile 4: odds ratio = 1.41, 95% confidence interval = 1.09–1.82). The association remained valid among women when stratified by sex. There was no significant result in men. Traumatic events in women were positively associated with the augmentation index. These findings suggest that more attention should be paid to trauma in the context of increased cardiovascular risk in women.

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Fig. 1


  1. 1.

    Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51:1237–46.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Korkeila J, Vahtera J, Korkeila K, Kivimäki M, Sumanen M, Koskenvuo K, et al. Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease. Heart. 2010;96:298–303.

    PubMed  Google Scholar 

  3. 3.

    Rich-Edwards JW, Mason S, Rexrode K, Spiegelman D, Hibert E, Kawachi I, et al. Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation. 2012;126:920–7.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469–500.

    PubMed  Google Scholar 

  5. 5.

    Gullette EC, Blumenthal JA, Babyak M, Jiang W, Waugh RA, Frid DJ, et al. Effects of mental stress on myocardial ischemia during daily life. JAMA. 1997;277:1521–6.

    CAS  PubMed  Google Scholar 

  6. 6.

    Cameron A, Palm K, Follette V. Reaction to stressful life events: what predicts symptom severity? J Anxiety Disord. 2010;24:645–9.

    PubMed  Google Scholar 

  7. 7.

    Furniss T, Beyer T, Müller JM. Impact of life events on child mental health before school entry at age six. Eur child Adolesc psychiatry. 2009;18:717–24.

    PubMed  Google Scholar 

  8. 8.

    Hendrickson CM, Neylan TC, Na B, Regan M, Zhang Q, Cohen BE. Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: findings from the Heart and Soul Study. Psychosom Med. 2013;75:849–55.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Sumner JA, Kubzansky LD, Elkind MS, Roberts AL, Agnew-Blais J, Chen Q, et al. Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation. 2015;132:251–9.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192–217.

    CAS  PubMed  Google Scholar 

  11. 11.

    Rozanski A, Bairey CN, Krantz DS, Friedman J, Resser KJ, Morell M, et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. New Engl J Med. 1988;318:1005–12.

    CAS  PubMed  Google Scholar 

  12. 12.

    Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. New Engl J Med. 2005;352:539–48.

    CAS  PubMed  Google Scholar 

  13. 13.

    Laurent S. European network for non-invasive investigation of large arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.

    PubMed  Google Scholar 

  14. 14.

    Yannoutsos A, Ahouah M, Tubiana CD, Topouchian J, Safar ME, Blacher J. Aortic stiffness improves the prediction of both diagnosis and severity of coronary artery disease. Hypertens Res. 2018;41:118–25.

    PubMed  Google Scholar 

  15. 15.

    Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S. Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation. 1999;100:1387–93.

    CAS  PubMed  Google Scholar 

  16. 16.

    Bomhof-Roordink H, Seldenrijk A, van Hout HP, van Marwijk HW, Diamant M, Penninx BW. Associations between life stress and subclinical cardiovascular disease are partly mediated by depressive and anxiety symptoms. J Psychosom Res. 2015;78:332–9.

    PubMed  Google Scholar 

  17. 17.

    OECD. Health at a glance 2013: OECD Indicators, OECD Publishing, Paris. 2013.

  18. 18.

    Shim JS, Song BM, Lee JH, Lee SW, Park JH, Choi DP, et al. Cardiovascular and metabolic diseases etiology research center (CMERC) cohort: study protocol and results of the first 3 years of enrollment. Epidemiol Health. 2017;39:e2017016.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Sarason IG, Johnson JH, Siegel JM. Assessing the impact of life changes: development of the Life Experiences Survey. J consulting Clin Psychol. 1978;46:932.

    CAS  Google Scholar 

  20. 20.

    Lee Y-H. Relations between attributional style, life events, event attribution, hopelessness and depression. Unpublished doctoral dissertation. Seoul: Seoul National University. 1993.

  21. 21.

    Morgan CA III, Hazlett G, Wang S, Richardson EG Jr, Schnurr P, Southwick SM. Symptoms of dissociation in humans experiencing acute, uncontrollable stress: a prospective investigation. Am J Psychiatry. 2001;158:1239–47.

    PubMed  Google Scholar 

  22. 22.

    Schnurr P, Vielhauer M, Weathers F, Findler M. The brief trauma questionnaire. White River Junction, VT: National Center for PTSD. 1999.

    Google Scholar 

  23. 23.

    Kim M, Lee I, Lee C. In female university students sample= the validation study 1 of Korean BDI-2. Korean J Clin Psychol. 2007;26:997–1014.

    Google Scholar 

  24. 24.

    Weber T, Auer J, O’rourke MF, Kvas E, Lassnig E, Berent R, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004;109:184–9.

    PubMed  Google Scholar 

  25. 25.

    Wilkinson IB, Prasad K, Hall IR, Thomas A, MacCallum H, Webb DJ, et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol. 2002;39:1005–11.

    PubMed  Google Scholar 

  26. 26.

    Duprez DA, Kaiser DR, Whitwam W, Finkelstein S, Belalcazar A, Patterson R, et al. Determinants of radial artery pulse wave analysis in asymptomatic individuals. Am J hypertension. 2004;17:647–53.

    Google Scholar 

  27. 27.

    Kelly R, Hayward C, Avolio A, O’rourke M. Noninvasive determination of age-related changes in the human arterial pulse. Circulation. 1989;80:1652–9.

    CAS  PubMed  Google Scholar 

  28. 28.

    Lee JH, Choi DP, Shim J-S, Kim DJ, Park S-H, Kim HC. Inter-rater reliability of carotid intima-media thickness measurements in a multicenter cohort study. J Health Info Stat. 2016;41:49–56.

    Google Scholar 

  29. 29.

    Gkaliagkousi E, Douma S. The pathogenesis of arterial stiffness and its prognostic value in essential hypertension and cardiovascular diseases. Hippokratia. 2009;13:70.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Ahn KT, Park K-I, Kim MJ, Oh JK, Han JH, Kwon HJ, et al. Height and sex is strongly associated with radial augmentation index in Korean patients with never-treated hypertension. Clin Interventions Aging. 2016;11:415.

    Google Scholar 

  31. 31.

    Kanner AD, Coyne JC, Schaefer C, Lazarus RS. Comparison of two modes of stress measurement: daily hassles and uplifts versus major life events. J Behav Med. 1981;4:1–39.

    CAS  PubMed  Google Scholar 

  32. 32.

    Brugha TS, Cragg D. The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand. 1990;82:77–81.

    CAS  PubMed  Google Scholar 

  33. 33.

    Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, et al. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004;110:1761–6.

    PubMed  Google Scholar 

  34. 34.

    Jern S, Pilhall M, Jern C, Carlsson SG. Short-term reproducibility of a mental arithmetic stress test. Clin Sci. 1991;81:593–601.

    CAS  PubMed  Google Scholar 

  35. 35.

    Vlachopoulos C, Kosmopoulou F, Alexopoulos N, Ioakeimidis N, Siasos G, Stefanadis C. Acute mental stress has a prolonged unfavorable effect on arterial stiffness and wave reflections. Psychosom Med. 2006;68:231–7.

    PubMed  Google Scholar 

  36. 36.

    Seldenrijk A, Van Hout HP, van Marwijk HW, de Groot E, Gort J, Rustemeijer C, et al. Carotid atherosclerosis in depression and anxiety: associations for age of depression onset. World J Biol Psychiatry. 2011;12:549–58.

    PubMed  Google Scholar 

  37. 37.

    DeCara JM. Carotid intima-media thickness and risk for coronary heart disease. Curr Cardiovascular Imaging Rep. 2009;2:350.

    Google Scholar 

  38. 38.

    Onete V, Henry RM, Sep SJS, Koster A, van der Kallen CJ, Dagnelie PC, et al. Arterial stiffness is associated with depression in middle-aged men - the Maastricht Study. J Psychiatr Neurosci. 2018;43:111–9.

    Google Scholar 

  39. 39.

    Laurent S, Kingwell B, Bank A, Weber M, Struijker-Boudier H. Clinical applications of arterial stiffness: Therapeutics and pharmacology. Am J Hypertension. 2002;15:453–8.

    Google Scholar 

  40. 40.

    Low CA, Salomon K, Matthews KA. Chronic life stress, cardiovascular reactivity, and subclinical cardiovascular disease in adolescents. Psychosom Med. 2009;71:927.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Gold SD, Marx BP, Soler-Baillo JM, Sloan DM. Is life stress more traumatic than traumatic stress? J Anxiety Disord. 2005;19:687–98.

    PubMed  Google Scholar 

  42. 42.

    Van Hooff M, McFarlane AC, Baur J, Abraham M, Barnes DJ. The stressor Criterion-A1 and PTSD: a matter of opinion? J Anxiety Disord. 2009;23:77–86.

    PubMed  Google Scholar 

  43. 43.

    Edmondson D, Cohen BE. Posttraumatic stress disorder and cardiovascular disease. Prog Cardiovasc Dis. 2013;55:548–56.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Gill JM, Saligan L, Woods S, Page G. PTSD is associated with an excess of inflammatory immune activities. Perspect Psychiatr Care. 2009;45:262–77.

    PubMed  Google Scholar 

  45. 45.

    Brudey C, Park J, Wiaderkiewicz J, Kobayashi I, Mellman TA, Marvar PJ. Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease. Am J Physiol Regul Integr Comp Physiol. 2015;309:R315–R321.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Phillips AC, Carroll D, Ring C, Sweeting H, West P. Life events and acute cardiovascular reactions to mental stress: a cohort study. Psychosom Med. 2005;67:384–92.

    PubMed  Google Scholar 

  47. 47.

    Boyce WT, Chesterman E. Life events, social support, and cardiovascular reactivity in adolescence. J Dev Behav Pediatr. 1990;11:105–11.

    CAS  PubMed  Google Scholar 

  48. 48.

    Musante L, Treiber FA, Kapuku G, Moore D, Davis H, Strong WB. The effects of life events on cardiovascular reactivity to behavioral stressors as a function of socioeconomic status, ethnicity, and sex. Psychosom Med. 2000;62:760–7.

    CAS  PubMed  Google Scholar 

  49. 49.

    Jorgensen RS, Houston BK. Reporting of life events, family history of hypertension, and cardiovascular activity at rest and during psychological stress. Biol Psychol. 1989;28:135–48.

    CAS  PubMed  Google Scholar 

  50. 50.

    Seelig AD, Rivera AC, Powell TM, Williams EC, Peterson AV, Littman AJ, et al. Patterns of smoking and unhealthy alcohol use following sexual trauma among US Service members. J Trauma Stress. 2017;30:502–11.

    PubMed  Google Scholar 

  51. 51.

    Vlachopoulos C, Alexopoulos N, Stefanadis C. Lifestyle modification and arterial stiffness and wave reflections: a more natural way to prolong arterial health. Artery Res. 2006;1:S15–S22.

    Google Scholar 

  52. 52.

    Faggiano A, Pivonello R, Spiezia S, De Martino MC, Filippella M, Di Somma C, et al. Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing’s disease during active disease and 1 year after disease remission. J Clin Endocrinol Metabol. 2003;88:2527–33.

    CAS  Google Scholar 

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This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (grant number 2018R1C1B5083722) and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number HI13C0715).

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Correspondence to Hyeon Chang Kim.

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The protocol of this study was approved by the Institutional Review Board of Yonsei University (YUIRB- 4-2013-0661), and written informed consent was provided by all participants. All procedures in this work complied with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

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Jung, S.J., Jeon, Y., Lee, G. et al. Stressful life events and augmentation index: results from the Cardiovascular and Metabolic Diseases Etiology Research Center. Hypertens Res 43, 45–54 (2020).

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  • Psychological trauma/stress
  • Psychological/vascular stiffness/cardiovascular diseases
  • Carotid intima-media thickness


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