Perceived stress, adherence to dietary guidelines and incident cardiovascular disease: findings from the Australian Longitudinal Study on Women’s Health

Previous research suggests perceived stress and healthy eating are associated with cardiovascular disease (CVD) risk, but studies investigating their combined association are lacking. The aim was to assess associations between stress, adherence to dietary guidelines and CVD, individually and combined. Data from the Australian Longitudinal Study on Women's Health (ALSWH) including 9303 women (52 ± 2 y) without history of CVD were analysed. Dietary and perceived stress data were collected with validated questionnaires, respectively, with the 74 item food frequency questionnaire and a questionnaire addressing 10 different life domains. Adherence to dietary guidelines was defined by using two guideline indices, the Australian Dietary Guidelines Index (DGI) and the food-based Dutch Healthy Diet Index-15 (DHD-15). Hard incident CVD events were collected from linked hospital physician diagnosis data. Cox proportional hazards models were performed adjusted for multiple covariates, being demographic, socioeconomic, health and behavioural factors. During 15 years follow-up 1091 CVD incident events occurred. Higher compared to lower perceived stress at baseline was significantly associated with higher incidence of CVD both in crude (HR = 1.32, 95%CI: 1.13, 1.54) and adjusted (HR = 1.30, 95%CI: 1.10, 1.52) models. No associations between neither the DGI-2013 score nor the DHD15 index score and CVD incidence were found. Also, no interaction between perceived stress and adherence to dietary guidelines was shown. The current study underscores the importance of perceived stress levels as an independent risk factor for CVD incidence among women. Thus, stress management could be important for CVD risk reduction.