Associations between Chronic Stress, Resilience Resources, and Cardiovascular Health among Young Adults in Puerto Rico: the PR-OUTLOOK study

Background: Cardiovascular outcomes for young adults, particularly Latino individuals, have worsened, in contrast with trends for older persons. Stress and psychosocial resilience resources have been associated with cardiovascular health (CVH) among middle-aged and older adults, but these associations have not been characterized in young adults and Latino populations. We examined the association between chronic stress, resilience resources, and CVH in PR-OUTLOOK, a large community cohort study of 18-29 year olds residing in Puerto Rico. Methods: Participants (n=2,676; 61.9% female) were assessed between September 2020 and March 2024. The American Heart Association Life?s Essential 8 (LE8), derived from surveys, laboratory assays, and physical examinations (range: 0-100, suboptimal CVH = <80) measured CVH. Surveys assessed chronic stress and resilience resources (optimism, religiosity, spirituality, and social support). Multivariable logistic regression, adjusting for age, sex, marital status, subjective social standing, and maternal education, examined associations between chronic stress and CVH, and the potential protective effect of resilience resources (moderation effect). With mediation analysis, using nonparametric bootstrap standard errors with 1,000 replications, we tested whether resilience factors were in the pathway of the stress-CVH association (mediation effect). Results: High chronic stress was associated with suboptimal CVH (OR=1.46; 95% CI: 1.19, 1.80) and resilience factors did not moderate this association (all p > 0.05); however, optimism and social support mediated it, accounting for 26% and 10% of the association, respectively. Conclusions: Chronic stress was associated with suboptimal CVH directly and indirectly through lower resilience resources. Longitudinal studies should better characterize these associations.