JP Stroke Foundation

Cardiovascular disease is caused by many different factors. Of these factors, stress is a major one. In fact, stress is one of the most common complaints recorded throughout the entirety of medicine [2]. Stress is mainly brought about by situational factors, and depends on the environment an individual is in. Examples of situations that can cause stress include marital stress, job stress, financial stress, and stress related to socioeconomic barriers [2]. These factors affect different demographics at different extents. Accordingly, there are ones that pertain more to individuals of lower socioeconomic class (SES) and racialized/minority communities.

Evidence shows that racialized and ethnic individuals have an increased amount of stress as a result of perceived racism [3]. When looking at the fact that stigmatized individuals undergo more prejudice and discrimination than non-stigmatized individuals, such evidence begins to come into perspective [3]. These individuals may also be sensitized to future stressors and thus have a greater reaction to them as well [3]. Racial stress is also an addition to all the other stress factors that these individuals may already be encountering in their day to day lives. Additionally, race related stress can also increase one’s tendency to take part in behaviours that will negatively impact their health which in turn increases their risk of cardiovascular disease [1].

Individuals of lower socioeconomic classes also encounter greater stress and therefore have an increased risk of cardiovascular disease. Before delving into how socioeconomic status impacts stress levels, let’s understand how socioeconomic status is measured. There are four markers for socioeconomic status including income level, educational attainment, environmental factors, and employment status [4]. These markers go hand in hand as the level of education will determine one’s employment status which will then determine their income level. For example, if an individual with a big family doesn’t have a university degree, they will have a harder time trying to find a job that will meet their family needs, and thus have a lower income which may result in insufficient food for the family. A competing scenario to consider is an individual who had to drop out of school to work to support their family, but in turn was unable to attain a higher degree and thus isn’t able to get a higher paying job. This inability to provide their family with enough food and shelter would be a major stress factor. Accordingly, just like race related stress, SES related stress can also increase a person’s likelihood of participating in negative health behaviours [4]. Consequently, these factors would increase the risk of developing cardiovascular disease.

It is extremely difficult for individuals in these groups to decrease the amount of stress they are experiencing but there are interventions that may help. For example, providing social supports to individuals in a specific area could help relieve some of the stress faced by members of low SES. On top of this, giving counselling to those who may not be able to attain it can also help with lowering stress and identifying positive coping strategies [4]. There is still a large gap in knowledge regarding race related stress and cardiovascular diseases. It would be extremely beneficial if there was more research aimed at understanding the effects of discrimination as a stressor [1]. Along with this, it is also important for societies to unlearn the discriminatory concepts that have been imbedded within our system and actively reform policies in healthcare and policy. As a society we have to work towards supporting everyone and practicing equity to ensure that no one is left behind.

Author: Priya Amin

References

1) Brewer, L. P. C., & Cooper, L. A. (2014). Race, discrimination, and cardiovascular disease. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/race-discrimination-and-cardiovascular-disease/2014-06.

2) Dimsdale J. E. (2008). Psychological stress and cardiovascular disease. Journal of the American College of Cardiology, 51(13), 1237–1246 https://doi.org/10.1016/j.jacc.2007.12.024

3) Lepore, S. J., Revenson, T. A., Weinberger, S. L., Weston, P., Frisina, P. G., Robertson, R., Portillo, M. M., Jones, H., & Cross, W. (2006). Effects of social stressors on cardiovascular reactivity in Black and White women. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 31(2), 120–127. https://doi.org/10.1207/s15324796abm3102_3

4) Schultz, W. M., Kelli, H. M., Lisko, J. C., Varghese, T., Shen, J., Sandesara, P., Quyyumi, A. A., Taylor, H. A., Gulati, M., Harold, J. G., Mieres, J. H., Ferdinand, K. C., Mensah, G. A., Laurence S. (2018).Socioeconomic status and cardiovascular outcomes. Circulation. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029652.