Abstract MP53: Caregiving, Stress, and Depression Are Associated with Lower Achievement of Cardiovascular Health Metrics Among Women: The AHA’s Life’s Simple 7 and the Go Red for Women Strategically Focused Research Network
Authors: Aggarwal Brooke , Makarem Nour , Byun Stephanie , Mayat Zara , Liao Ming , Mochari Greenberger Heidi 
Published: March 2019

Background:
Women constitute the overwhelming majority of caregivers in the US, whether taking care of children, ill spouses, or others. Caregiving has been identified as an independent risk factor for CVD mortality, yet few data have evaluated caregiving and other coexisting psychosocial risk factors (e.g., stress, depression) with cardiovascular health (CVH) according to the AHA’s Life’s Simple 7 (LS7).

Hypothesis:
Caregiving, stress, and depression will be associated with meeting overall and individual metrics of CVH included in the AHA LS7 (smoking, diet, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol, and fasting glucose), among a diverse population of women across the life span.

Methods:
English/Spanish-speaking women aged 20-76 y, participating in the AHA Go Red for Women SFRN observational cohort study, were included (N=506, 61% racial/ethnic minority, mean age = 37 ±16y). Caregiver strain was assessed using the Caregiver Strain Index; psychological stress using the Perceived Stress Scale, and depressive symptoms using the Beck Depression Inventory-II. LS7 score was calculated using established methodology: metrics were scored as 0 (poor), 1 (moderate), and 2 (ideal), and then summed to create a total LS7 score such that higher scores reflected better CVH (0-8: poor, 9-11: moderate, 12-14: ideal). Linear regression models were used to evaluate cross-sectional associations between 1) caregiver strain, 2) psychological stress, and 3) depression, and the LS7 overall score and its components adjusted for age, race, ethnicity, education, and health insurance status.

Results:
More than one in five women in the sample reported significant caregiving responsibilities (all/most/some of the time); 29% of those had high levels of caregiver strain. Twenty-two percent had high levels of stress and 18% had depressive symptoms. Mean LS7 score was 9.68 ±2.2, and 27%, 33%, and 40% of women had poor, moderate, and ideal total scores, respectively. After adjustment for confounders, higher caregiver strain was associated with poorer LS7 score (β=-.08, p=.03), poorer diet score (β=-.02, p=.01) and poorer BMI score (β=-.04, p=.003). Greater caregiving responsibilities were associated with poorer BMI score (β=-.06, p=.01). Higher perceived stress was associated with poorer LS7 score (β=-.11, p=.008), and poorer diet score (β=-.02, p=.01). Having greater depressive symptoms was associated with poorer LS7 score (β=-.04, p=.001).

Conclusions:
Among a diverse cohort of women, psychosocial factors including caregiving, stress, and depression were associated with worse overall CVH and lower likelihood of meeting the LS7 metrics for healthy diet and BMI. Future research should determine if efforts to improve CVH among women are significantly enhanced by addressing dimensions of psychosocial health such as caregiver strain, stress, and depression.