Background: Patients after their first myocardial infarction are characterized by increased levels of perceived stress and abdominal obesity compared to a matched control group. In the setting of primary prevention, the association of stress and cardiovascular risk factors in obese and non-obese individuals is not known.
Methods and results: For this prospective cross-sectional study, primary care physicians recruited consecutive patients with BMI >30 and the next two individuals presenting with a BMI < 30 as controls (n=414). The 10-year risk of death from cardiovascular disease determined by the European Society of Cardiology HeartScore Germany was associated with BMI (p<0.0001). However, waist circumference and waist-to-hip ratio predicted the calculated cardiovascular risk better than BMI. Psychosocial risk factors were determined using the INTERHEART questionnaire. Obesity was positively associated with depression (p=0.005) but not with perceived stress. In contrast to obesity or depression, the extent of perceived general stress inversely correlated with cardiovascular risk (never stress: 4.4+/-2.8%, some period: 2.4+/-2.7%, several periods: 1.4+/-2.3% and permanent: 0.65+/-0.5%; p=0.0001). Similarly, additional parameters of stress (stress at home, stress at work, financial stress, stressful life events) as well as locus of control were inversely associated with cardiovascular risk factors. A medical history of general stress was correlated with younger age and increased smoking.
Conclusions: Waist to hip ratio powerfully predicts the cardiovascular risk estimated by HeartScore in primary prevention. Perceived stress assessed by a standardized questionnaire does not positively correlate with traditional cardiovascular risk factors and warrants further evaluation as a routine tool for primary care physicians.