Abstract Body: Introduction: The association between stress, resilience and cardiovascular health (CVH), as defined by the American Heart Association Life’s Essential 8 (LE8) metric, has not been well studied. We studied these associations among young adults in PR.
Hypothesis: Chronic stress is associated with suboptimal CVH among young adults in PR; however, culture-relevant resilience factors, including optimism, spirituality, religiosity, and social support, help mitigate this association.
Methods: Participants, aged 18-29 y and living in PR, completed assessments between September 2020 and November 2023 (60.8% female, n= 2,179). Participants completed measures of chronic stress (Chronic Burden scale, score dichotomized: low=0-1, high: >2), optimism (LOT-R; score range: 0-24), spirituality (DSES; scores: 1-80), religiosity (1 item; score: 0-2), and social support from family and friends (Walen & Lachman; score: 1-8). Resilience scores were treated as continuous variables. CVH (LE8) scores were derived from surveys, laboratory assays, and physical exams (scores:0-100, suboptimal = <80). Multivariable logistic regression was used to assess the association between chronic stress and CVH, followed by mediation analysis to determine whether resilience factors mitigated this association. Bias-corrected and accelerated 95% confidence intervals (CI) for the mediated proportions were estimated using bootstrapping with 1,000 replications. All models controlled for sex, age, subjective social standing, and mother’s education.
Results: Overall, 36% of participants had high scores for chronic stress. The mean and standard deviations for the resilient factors were 14.7 (4.3) for optimism, 35.4 (18.1) spirituality, 1.3 (0.7) religiosity, and 6.5 (1.1) social support, and 72.5% of participants had suboptimal CVH. In the adjusted analysis, chronic stress was significantly associated with suboptimal CVH (OR=1.42; 95%CI:1.16-1.75). Mediation analyses showed that 19% (95%CI:4.58-55.9) of this association was mediated by optimism and 13.7% (95% CI: 4.0-45.8) by social support.
Conclusion: The experience of chronic stress is associated with suboptimal CVH among young adults in PR. However, this association is mitigated by optimism and social support from friends and family. To increase the evidence base for preventive interventions, future research should assess longitudinal trajectories of these associations and pathways by which chronic stress and resilience factors may impact CVH.