TOPLINE:
Women who experienced stalking faced a significantly elevated risk for incident cardiovascular disease. While obtaining a restraining order can sometimes limit violence, even the issuance of such rulings — reflecting a history and severity of abuse — may have long-term consequences for cardiovascular health.
METHODOLOGY:
- Researchers analyzed data from more than 66,000 female nurses in the United States (mean age at the start of follow-up, 46.3 years) who reported whether they had ever been stalked or obtained a restraining order.
- Incident cardiovascular disease, defined as self-reported fatal or nonfatal myocardial infarction or stroke, was tracked over a median follow-up of 19.9 years.
- In a secondary analysis, medical records were reviewed to confirm or corroborate self-reported cardiovascular events, with approximately 53% of cases adjudicated.
- Analyses were adjusted for several potential factors including sociodemographic characteristics, family and childhood factors, and health behaviors and conditions in adulthood.
TAKEAWAY:
- Overall, 11.7% of women reported experiencing stalking, and 5.6% reported obtaining a restraining order.
- During follow-up, 2.8% of women reported developing cardiovascular disease, with 1.5% of cases confirmed through a review of medical records.
- Women who reported experiencing stalking had a 41% higher risk for self-reported incidence of cardiovascular disease than those who did not (adjusted hazard ratio [aHR], 1.41; 95% CI, 1.24-1.60); those who obtained a restraining order had a 70% higher risk than those who did not (aHR, 1.70; 95% CI, 1.44-1.98).
- Analyses of adjudicated cardiovascular events showed similarly elevated risks among women with a history of stalking or of obtaining a restraining order.
IN PRACTICE:
“Through obtaining a restraining order, women who have experienced violence are identified by agencies; this interaction provides an opportunity to support these women and possibly intervene to limit potential long-term cardiovascular health consequences,” the researchers reported.
“Attempts to understand women’s lives beyond traditional risk factors when evaluating [cardiovascular disease] risk likely warrants further attention for health care,” they added.
SOURCE:
This study was led by Rebecca B. Lawn, PhD, of Harvard T.H. Chan School of Public Health, Boston. It was published online on August 11, 2025, in Circulation.
LIMITATIONS:
The exposures to violence were self-reported and assessed retrospectively, potentially introducing recall bias and misclassification. The assessment lacked details about the timing of violence. The participants were drawn from an occupational cohort of registered nurses, limiting generalizability.
DISCLOSURES:
This study received support from the National Institutes of Health, National Institute of Mental Health, National Institute on Aging, and the Broad Trauma Initiative at the Broad Institute of MIT and Harvard. One author reported serving as a paid consultant for the US Department of Justice and Covington and Burling, LLP, and receiving royalties from Guilford Press and Oxford University Press. Another author reported serving on the medical advisory board of several pharmaceutical and healthcare companies and as a past consultant for Happify Health.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.