Higher stress in adolescence and young adulthood associated with greater cardiometabolic risk


An 18-year prospective study suggested that higher perceived stress in adolescence and young adulthood and high stress levels over time may contribute to increased cardiometabolic risk in young adults.

This summary is based on the publication of Guo F, Chen X, Howland, et al. - Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study. J Am Heart Assoc. 2024 Jan 17:e030741 [Online ahead of print]. doi: 10.1161/JAHA.123.030741

Introduction and methods


Although cardiometabolic diseases generally manifest in middle‐to‐late adulthood, the underlying pathological processes begin in childhood and may develop silently for decades [1]. Identification of childhood risk factors for cardiometabolic diseases could aid early intervention. Perceived stress is possibly such a risk factor.

Aim of the study

The authors investigated (1) the associations of perceived stress in childhood (parent‐reported), adolescence, and young adulthood with 7 markers of cardiometabolic risk in adulthood; and (2) whether adolescence-to-young adulthood perceived stress patterns predicted cardiometabolic risk in young adulthood.


This prospective study included 276 participants from the Southern California Children’s Health Study who were recruited in 2003 and followed every 1–2 years through the end of high school. Perceived stress was assessed using the Perceived Stress Scale (PSS) by participants’ parents for themselves during early childhood of the participants (mean age: 6.3 years) and self-reported in participants’ adolescence (13.3 years) and young adulthood (23.6 years). Cardiometabolic risk was assessed once in young adulthood by carotid artery intima-media thickness (CIMT), systolic and diastolic blood pressure (SBP/DBP), BMI, percent body fat, android/gynoid fat (AG) ratio, and HbA1c. The authors calculated a cumulative cardiometabolic risk score based on 5 clinically abnormal markers (CIMT >0.8 mm, SBP ≥130 mmHg or DBP ≥80 mmHg, percent body fat >25% (men) or >35% (women), AG ratio >85th percentile, and HbA1c ≥5.7%).

Main results

Associations between perceived stress at 3 time points and cardiometabolic risk indicators in adulthood

  • In young adulthood, a higher PSS score was associated with increased CIMT (β=0.01; 95%CI: 0.0003–0.02; P=0.043), SBP (β=1.27; 95%CI: 0.09–2.45; P=0.035), DBP (β=0.94; 95%CI: 0.13–1.75; P=0.024), and overall cardiometabolic risk (β=0.12; 95%CI: 0.01–0.22; P=0.031).
  • A higher PSS score during adolescence was only associated with a lower DBP (β: −1.11; 95%CI: −1.91 to −0.32; P=0.006) and greater odds of obesity (OR: 1.66; 95%CI: 1.16–2.38; P=0.006) in adulthood.
  • The parents’ PSS score during the participants’ childhood was not associated with any of the indicators of cardiometabolic risk in adulthood.

Associations between adolescence-to-young adulthood perceived stress patterns and cardiometabolic risk indicators in adulthood

  • Individuals with consistently high adolescence-to-young adulthood stress patterns had a higher AG ratio (β=0.07; 95%CI: 0.02–0.13; P=0.009), higher percent body fat (β=2.59; 95%CI: 0.01–5.17; P=0.049), greater odds of obesity (OR: 5.57; 95%CI: 1.62–19.10; P=0.006), and a greater overall cardiometabolic risk (β=0.31; 95%CI: 0.02–0.60; P=0.036) in adulthood, compared with those with consistently low stress patterns.
  • Participants with a decreasing PSS score over time also had greater odds of obesity (OR: 4.87; 95%CI: 1.30–18.34; P=0.019) compared with those with a consistently low PSS score.


In this prospective Southern-Californian study with an 18-year follow-up time, young adults with higher perceived stress showed greater risk of increased CIMT and elevated blood pressure, whereas adolescents with higher perceived stress were more likely to be obese in young adulthood. In addition, individuals who reported consistently high perceived stress from adolescence to young adulthood had a higher AG ratio and percent body fat and greater odds of obesity compared with individuals with consistently low perceived stress.

According to the authors, their “findings suggest that promoting healthy coping strategies for stress management early in life (e.g., adolescence) may facilitate the prevention of cardiometabolic diseases.”


1. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, Järvisalo MJ, Uhari M, Jokinen E, Rönnemaa T, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003;290:2277–2283. doi: 10.1001/jama.290.17.2277

Find this article online at J Am Heart Assoc.

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