Women who have been stalked may have higher risk of heart disease and stroke

Women who have been stalked or obtained a restraining order are more likely to experience a heart attack and/or stroke in later years compared to those who have not, according to new research.

The link between stalking and cardiovascular disease may be due to psychological distress, which may disrupt the nervous system, impair proper blood vessel function and negatively affect other biological mechanisms, the researchers said.

Rebecca B. Lawn, Ph.D. is a research associate in epidemiology at Harvard T.H. Chan School of Public Health in Boston and at the School of Population and Public Health at the University of British Columbia in Vancouver, Canada.

She said: “Although violence against women is common, and evidence has linked violence with consequences for women’s later heart health, it is still not widely recognised or routinely considered by health care professionals as a potential cardiovascular risk factor among women.

“We felt it was essential to look beyond traditional cardiovascular risk factors in women and strengthen our understanding of the relationship between underexplored types of violence and heart health.”

Researchers analysed stalking, restraining orders, and heart disease or stroke development among participants in the Nurses’ Health Study II, from 2001 to 2021.

The analysis includes data for more than 66,000 women, average age 46 years in 2001.

These women did not have cardiovascular disease in 2001, when they first shared whether they had experienced stalking or stalking harassment behaviors, such as receiving unsolicited correspondence, that made them fearful.

The study also asked if participants had “ever taken out” a restraining order, which is a legal document that seeks to limit contact between a victim and perpetrator.

Obtaining a restraining order was considered a sign of severe violence.

Overall, nearly 12 per cent of the women in the study reported that they had been stalked, while nearly 6 per cent of them said they had obtained a restraining order.

About 3 per cent of all women studied reported new-onset heart disease or stroke during the 20 years of the study.

Compared to women who had not been stalked, women who reported experiencing stalking were 41 per cent more likely to have cardiovascular disease.

Women who had obtained a restraining order were 70 per cent more likely to report cardiovascular disease versus those who had not.

Similarly, women whose medical records confirmed heart attacks or strokes were more likely to have reported being stalked or obtaining a restraining order.

The increased risks for heart attack and stroke associated with stalking and restraining orders remained despite the existence of other self-reported cardiovascular risk factors, such as health and lifestyle behaviors, medications, health conditions, childhood abuse and symptoms of depression.

Lawn said: “Stalking is often seen as a form of violence that does not involve physical contact, which may make it seem less serious.

“However, our findings suggest stalking should not be minimised.

“Stalking can be chronic, and women often report making significant changes in response such as moving.”

Harmony R. Reynolds, M.D., FAHA, immediate past chair of the American Heart Association’s Clinical Cardiology & Stroke Women’s Health Science Committee, said she was surprised at the strong association this study found between stalking and cardiovascular disease.

She said: “A variety of stressful life experiences are known to increase the risk of cardiovascular disease, including adverse childhood experiences, financial stressors, grief and other experiences.

“People subjected to intimate partner violence face about a 30 per cent higher risk of developing cardiovascular disease in the next few years compared to others.

While this study shows a more moderate risk, given the long-time frame, it highlights how feeling unsafe can affect the body, in addition to the mind.”

Reynolds, the Joel and Joan Smilow Professor of Cardiology and Director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Grossman School of Medicine in New York City, was not involved in this research, and noted that the effects of stress can be long-lasting.

She said: “Perhaps because it is our nature to re-think about things that happen to us, making us experience the situation over and over.

“However, social support may mitigate the effects of stress. It’s helpful to have people you can trust to talk with, whether they are family, friends, people in the community or professionals.”

Study authors note that the link between stalking and cardiovascular disease may be due to psychological distress, which may disrupt the nervous system, proper blood vessel function and other biological processes; however, these potential mechanisms were not examined in detail in this study.

Lawn said more research, as well as training for health care professionals, is needed to understand the link between stalking or obtaining a restraining order and women’s cardiovascular health.