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Issues in Women’s Health: Cardiovascular Disease

Christina Psaros, PhD, Women’s Health SIG Co-Chair
Valessa St. Pierre, MS, Women’s Health SIG Co-Chair

Cardiovascular disease (CVD) is the leading cause of death for women in the United States, accounting for one out of every four female deaths.1 Rates of CVD among African American women are almost 60% higher than those observed in white women.2 Despite research on the multiple lifestyle, environmental and biologic factors contributing to this disparity, these racial/ethnic differences in CVD are not yet well understood.2, 3

One psychosocial factor believed to be important for CVD-risk among women, and black women in particular, is the stress associated with filling multiple social roles.4 Very few studies have examined multiple role-related stress and CVD and whether there are racial/ethnic differences in role perceptions and CVD-risk. A recent article published in the Annals of Behavioral Medicine, a publication of the Society of Behavioral Medicine, aimed to fill this gap. Janseen et al.5 examined the associations between multiple social roles and a subclinical precursor of CVD in a sample of middle-aged black and white women.

Subjects were 104 black and 232 white women (ages 42-52 years of age) from The Study of Women’s Health Across the Nation (SWAN) study, a multi-site, multi-ethnic longitudinal study of women transitioning through menopause.  In order to assess their sociodemographic and CVD risk factors, women completed baseline and annual exams which included questionnaires, anthropometry and a blood draw. A woman’s fulfillment of specific social roles was assessed using a short questionnaire adapted from the Multiple Role Questionnaire.6 Four roles (spouse, parent, employee, caregiver) and the stress associated with occupying each role were assessed using a five-point scale.  The amount of calcium in the coronary arteries was assessed using an electron beam and calcium progression was defined as an increase of ≥ 10 Agatston units. Covariates included age, highest educational degree, smoking status, hormone therapy use, menopausal status, blood pressure, social support, depressive symptoms and body mass index.  Data were analyzed using relative risk regression models, which summarized the association between progression of coronary calcium and the participant’s attributes and the number of roles, average role stress, average role rewards and covariates.

Janseen et al.5 found that rewarding roles may be beneficial for black women. Specifically, they found that although white women reported higher rewards from their multiple social roles than their black counterparts, black women showed cardiovascular benefits from social role rewards. Further, among black women only, higher social role rewards were significantly related to lower progression of coronary artery calcium even after adjusting for several covariates including blood pressure and body mass index.  Blacks reported fewer social roles but similar social role stress as whites however social role number and stress were unrelated to coronary artery calcium progression.

Hence, perceived rewards from multiple rewarding social roles may be a protective psychosocial factor for the progression of coronary calcium among black women. Given that black women are at a high risk of developing CVD, future research should examine this and other protective psychosocial factors.

The study discussed above serves to highlight the unique needs of African American women living with CVD and highlights the importance of social roles as they relate to CVD. The study illustrates a primary goal of the Women’s Health special interest group, to support the advancement of women’s issues in behavioral medicine.  

Emily Russell, MPH
Member, Women’s Health SIG
Doctoral Candidate, Behavioral Sciences and Health Education Department
Emory University


  1. Kochanek KD, Xu, J.Q., Murphy, S.L., Minino, A.M., Kung, H.C. Deaths: Final data for 2009. National Vital Statistics Reports. 2011;60(3).
  2. Gillum RF, Mussolino, M.E., Madans, J.H. Coronary heart disease incidence and survival in African-American women and men. The NHANES I epidemiologic follow-up study. . Annals of Internal Medicine. 1997;127:111-118.
  3. Albert MA. Receipt of high-quality coronary heart  disease care in the United States: All about being black or white: Comment on "Racial differences in admissions to high quality hospitals for coronary heart disease". Archives of Internal Medicine. 2010;170:1216-1217.
  4. Low CA, Thurston, R.C., Matthews, K.A. Psychosocial factors in the development of heart disease in women: Current research and future directions. Psychosomatic Medicine. 2010;72(842-854).
  5. Janseen I, Powell, L.H., Jasielec, M.S., Matthews, K.A., Hollenberg, S.M., Sutton-Tyrrell, K., Everson-Rose, S.A. Progression of coronary artery calcification in black and white women: do the stresses and rewards of multiple roles matter? . Annals of Behavioral Medicine. 2012;43(1):39-49.
  6. Stephens MAP, Franks, M.M., Townsend, A.L. Stress and rewards in women's multiple roles: The case of women in the middle. Psychology and Aging. 1994;9:45-52.