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A Path Model of Chronic Stress, the Metabolic Syndrome, and Coronary Heart Disease

Vitaliano, Peter P. PhD; Scanlan, James M. PhD; Zhang, Jianping MS; Savage, Margaret V. PhD; Hirsch, Irl B. MD, and; Siegler, Ilene C. PhD, MPH

Original Articles

Objective We tested a theoretical stress model cross-sectionally and prospectively that examined whether relationships of chronic stress, psychophysiology, and coronary heart disease (CHD) varied in older adult men (N = 47), older adult women not using hormone replacement therapy (HRT) (N = 64), and older adult women using HRT (N = 41).

Method Structural equations examined relationships of CHD with 1) chronic stress (caring for a spouse with Alzheimer’s disease and patient functioning), 2) vulnerability (anger and hostility), 3) social resources (supports), 4) psychological distress (burden, sleep problems, and low uplifts), 5) poor health habits (high-caloric, high-fat diet and limited exercise), and 6) the metabolic syndrome (MS) (blood pressure, obesity, insulin, glucose, and lipids).

Results Caregiver men had a greater prevalence of CHD (13/24) than did noncaregiver men (6/23) (p < .05) 27 to 30 months after study entry. This was influenced by pathways from caregiving to distress, distress to the MS, and the MS to CHD. In men, poor health habits predicted the MS 15 to 18 months later, and the MS predicted new CHD cases over 27 to 30 months. In women, no “caregiving-CHD” relationship occurred; however, 15 to 18 months after study entry women not using HRT showed “distress-MS” and “MS-CHD” relationships. In women using HRT, associations did not occur among distress, the MS, and CHD, but poor health habits and the MS were related.

Conclusions In older men, pathways occurred from chronic stress to distress to the metabolic syndrome, which in turn predicted CHD. Older women not using HRT showed fewer pathways than men; however, over time, distress, the MS, and CHD were related. No psychophysiological pathways occurred in older women using HRT.

Departments of Psychiatry and Behavioral Sciences and Medicine, University of Washington (P.P.V., J.M.S., J.Z., M.V.S.), Seattle, Washington, and Department of Psychiatry and Behavioral Sciences, Duke University (I.C.S.), Durham, North Carolina.

Address reprint requests to: Peter P. Vitaliano, PhD, University of Washington, Department of Psychiatry and Behavioral Sciences, Box 356560, Seattle, WA 98195-6560. Email:

Received for publication July 27, 2000; revision received June 22, 2001.

Copyright © 2002 by American Psychosomatic Society
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