Women who reported being stalked or who obtained a restraining order were significantly more likely to later experience a heart attack or stroke compared to those who did not, according to new research from the UBC Faculty of Medicine and Harvard T.H. Chan School of Public Health.
The study, published in the American Heart Association’s journal Circulation, analyzed data from more than 66,000 women in the U.S. between 2001 and 2021. The findings suggest that violence against women may affect heart health and should be considered alongside traditional cardiovascular risk factors.
“Although violence against women is common, and evidence has linked violence with consequences for women’s later heart health, it is still not widely recognized or routinely considered by health care professionals as a potential cardiovascular risk factor among women,” said study author Dr. Rebecca Lawn, a research associate at the UBC School of Population and Public Health and with the Edwin S.H. Leong Centre for Health Aging at UBC.
“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,” added Dr. Lawn, who recently joined UBC from the Harvard T.H. Chan School of Public Health, where she was a research associate and completed part of work for the study.
About one in three women have been stalked at some point in their lives, according to data on intimate partner violence collected by the U.S. Centers for Disease Control and Prevention.
The study notes that common forms of violence against women, such as stalking, are rarely discussed in cardiovascular research. However, previous research by Dr. Lawn linked sexual assault and workplace harassment to higher blood pressure in women, while other studies report that people with restraining orders are more likely to experience poorer health.
Uncovering the hidden toll of violence
For the study, the research team analyzed stalking, restraining orders and heart disease or stroke development among participants in the Nurses’ Health Study II, part of an ongoing survey of U.S. female nurses.
The women did not have cardiovascular disease at the time of enrollment in 2001, when they first shared whether they had experienced stalking or stalking harassment behaviors, such as receiving unsolicited correspondence. The study also asked if participants had ever taken out a legal restraining order, which was considered a sign of severe violence.
Over the 20-year study period, women self-reported cardiac incidents that were later verified using medical records. The analysis found:
- Nearly 12 per cent of the women reported being stalked, while nearly six per cent reporting obtainment of a restraining order.
- About three per cent of women reported new-onset heart disease or stroke.
- Women who reported experiencing stalking were 41 per cent more likely to have cardiovascular disease compared to those who did not.
- Women who had obtained a restraining order were 70 per cent more likely to report cardiovascular disease compared those who had not.
Notably, 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.
“Stalking is often seen as a form of violence that does not involve physical contact, which may make it seem less serious,” said Dr. Lawn. “However, our findings suggest stalking should not be minimized. Stalking can be chronic, and women often report making significant changes in response such as moving.”
We need to increase awareness about the potential health harms of experiencing violence and provide women with help and resources.
Dr. Rebecca Lawn
The 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.
Dr. Lawn said more research is needed to understand the link between stalking or obtaining a restraining order and women’s cardiovascular health, as is more awareness among health care professionals.
“We also need to increase awareness about the potential health harms of experiencing violence and provide women with help and resources,” she said.
A version of this story was originally published on the American Heart Association website.