Women who have experienced being stalked, obtaining a restraining order (an indicator of severe violence) or both are significantly more likely to develop cardiovascular disease than women without these experiences, according to a study published Aug. 11 in Circulation.

Rebecca B. Lawn, PhD, et al., analyzed data from a cohort of 66,270 U.S. women enrolled in the Nurses' Health Study II between 2001 and 2021. Those included were free of cardiovascular disease at baseline and completed a questionnaire asking whether they had been stalked or had obtained a restraining order. Their mean age was 46 years and 93% were non-Hispanic White.

Results showed that over 20 years, 12% reported experiencing stalking and 6% reported obtaining a restraining order. Overall, 43% reported intimate partner violence (IPV). Of women who experienced stalking, 72% also reported IPV.

Regarding cardiovascular disease, 3% self-reported experiencing an event (defined as myocardial infarction or stroke). Findings revealed that the risk of incident cardiovascular disease was 41% higher in women who reported experiencing stalking than those who did not, after adjusting for sociodemographic, childhood or family factors. Moreover, the risk of incident cardiovascular disease was 70% higher in women who reported obtaining a restraining order than those who did not.

Notably, women who reported both experiencing being stalked and obtaining a restraining order had the highest risk of cardiovascular disease compared with women who reported neither exposure (HR, 2.16).

The link between stalking and cardiovascular disease may be due to psychological distress, which may disrupt the nervous system, impair endothelial function and negatively affect other biological mechanisms, the study authors write.

The authors conclude, “Overall, our findings highlight the urgent need to consider violence against women, a prevalent yet underexplored risk factor for [cardiovascular disease], in understanding women’s health and orienting priorities for public health interventions.”