Cardiovascular Disease, Perceived Stress, and Physical Activity: Population-Level Associations Relevant to Cardiovascular Physiology

Medical advances have markedly improved survival among patients with cardiovascular disease (CVD). Psychosocial and behavioral factors, including stress and physical activity, are increasingly recognized as key determinants of outcomes in this population. We investigated the association between existing CVD and perceived stress and examined how this association was modulated by physical activity levels in a Danish cohort, accounting for physiological and psychosocial conditions. We analyzed data on 102,650 Danish residents aged 50-65 years by linking self-reported questionnaire data from the Better Health in Late Life cohort with national health registry data. CVD was identified using hospital discharge diagnoses. Stress was measured with the ten-item Perceived Stress Scale. Physical activity was assessed with a pilot-tested questionnaire. Seven percent of participants had CVD. Compared with those without CVD, they had a higher prevalence of moderate-to-high perceived stress (42% vs. 33%) and a slightly lower prevalence of meeting guideline-recommended physical activity (42% vs. 45%). High stress was associated with physical activity not meeting the recommended level in both groups; however, this association was stronger among those with vs. without CVD (prevalence ratio 2.01 (95% confidence interval [CI]: 1.89-2.14) versus 1.52 (95% CI: 1.48-1.56)). We observed similar associations between stress and cardiovascular risk factors, comorbidity, psychosocial factors, and socioeconomic status. The association between stress and low physical activity persisted after stratification by these conditions. In conclusion, high stress was most strongly associated with low physical activity among adults with CVD. The underlying mechanisms seem to extend beyond physiological pathways and need further investigation.