For decades, cardiovascular research has largely focused on traditional risk factors such as diet, exercise, genetics, smoking, or high blood pressure. But new evidence reveals that psychosocial stressors—particularly violence against women—may also play a significant role in women’s heart health.
A groundbreaking study led by researchers from Harvard T.H. Chan School of Public Health and the University of British Columbia (UBC) has now uncovered a troubling connection: women who reported being stalked were 41% more likely to develop cardiovascular disease, including heart attacks and strokes, compared to women who had not been stalked.
Even more striking, women who had obtained a restraining order—a formal step taken to protect themselves from stalking or harassment—were found to have a 70% higher risk of cardiovascular disease.
This study, published in the American Heart Association’s journal Circulation, highlights how forms of violence that are often dismissed as “non-physical” can have lasting, life-threatening consequences on women’s health.
Understanding the Study: Who Was Involved?
The research was conducted using data from the Nurses’ Health Study II, one of the largest and longest-running health surveys of women in the United States.
- Participants: 66,270 women
- Age range at enrollment (2001): 36–56 years
- Duration of follow-up: 20 years
- Health baseline: None of the women had cardiovascular disease at the start of the study.
In 2001, participants were asked whether they had ever experienced stalking or harassment behaviors—such as unsolicited messages, following, or repeated unwanted contact—that made them fearful. They were also asked whether they had ever obtained a restraining order.
Over the next two decades, researchers tracked new cases of heart disease and stroke among these women, verifying self-reported events with medical records.
Key Findings: How Stalking Affects Women’s Hearts
The study yielded sobering results:
- 12% of women (nearly 8,000 participants) reported having been stalked at some point in their lives.
- 6% of women (around 4,000 participants) had obtained a restraining order.
- 3% of women (about 2,000 participants) developed cardiovascular disease over the study period.
Most importantly:
- Women who had been stalked were 41% more likely to develop heart disease or stroke.
- Women who had obtained a restraining order were 70% more likely to develop cardiovascular disease.
These risks persisted even after accounting for traditional heart health factors such as smoking, obesity, physical activity, medication use, and even childhood abuse.
Why Does Stalking Increase Heart Attack and Stroke Risk?
While stalking may not always involve physical harm, its psychological toll is severe and often chronic. The study’s lead author, Rebecca B. Lawn, Ph.D., explained that stalking creates a state of constant stress, hypervigilance, and fear, which can profoundly affect the body over time.
Here are some ways stalking may translate into cardiovascular problems:
- Chronic Stress Response
- Stalking often triggers the “fight-or-flight” response for extended periods.
- This increases levels of cortisol and adrenaline, hormones that raise blood pressure and strain the heart.
- Sleep Disruption
- Victims often report insomnia or poor sleep due to fear or anxiety.
- Poor sleep is a well-established risk factor for hypertension and heart disease.
- Mental Health Burden
- Stalking is linked to anxiety, depression, and PTSD.
- These conditions, in turn, increase cardiovascular risk.
- Behavioral Changes
- Some women may cope by avoiding exercise, overeating, or increased alcohol use, indirectly worsening heart health.
- Social Isolation
- Victims often move homes, change jobs, or cut ties to protect themselves.
- Social isolation is independently linked to cardiovascular disease.
The Role of Restraining Orders: Why Risk Is Higher
One of the more surprising findings was the 70% higher risk of heart disease among women who obtained restraining orders.
Researchers suggest this may be because:
- Women who take legal steps like restraining orders are often those facing more severe or prolonged harassment.
- The process of seeking legal protection can itself be stressful, emotionally draining, and retraumatizing.
- Even with a restraining order, many women continue to feel unsafe, as orders are not always enforced effectively.
Thus, restraining orders may serve as a marker for greater exposure to violence and chronic stress, explaining the elevated cardiovascular risk.
Stalking: An Overlooked Form of Violence
Stalking is often minimized because it does not always involve direct physical harm. Yet, according to the U.S. Centers for Disease Control and Prevention (CDC):
- 1 in 3 women report being stalked at some point in their lives.
- Stalking behaviors include unwanted contact, surveillance, threats, or harassment that instill fear.
Dr. Lawn emphasized that stalking is a form of violence—one that can force women to make major life changes, such as moving homes, changing phone numbers, or altering daily routines. These disruptions add to the stress burden, contributing to long-term health consequences.
Previous Research: Building the Case
This is not the first time violence against women has been linked to cardiovascular risk.
- Sexual Assault & Workplace Harassment: Previous studies by Dr. Lawn found that women who had experienced these forms of violence were more likely to develop high blood pressure.
- Childhood Abuse: Decades of research have linked adverse childhood experiences (ACEs) to a higher risk of adult cardiovascular disease.
- Domestic Violence: Women who experience intimate partner violence are at higher risk for mental health disorders and heart problems.
What makes the current study groundbreaking is that it explicitly highlights stalking, a form of violence rarely considered in medical research.
Implications for Healthcare
The findings call for a major shift in how healthcare professionals assess women’s cardiovascular risk. Traditionally, doctors focus on:
- Family history
- Blood pressure
- Cholesterol levels
- Smoking or drinking habits
- Weight and physical activity
But as Dr. Lawn argues, exposure to violence should also be recognized as a risk factor.
Potential Changes in Practice:
- Screening for violence: Healthcare providers could ask women about stalking, harassment, or abuse during routine visits.
- Integrating care: Cardiologists, mental health specialists, and social workers may need to work together.
- Preventive support: Women at risk could be offered stress management, counseling, and early interventions for heart health.
A Preventable Problem
Perhaps the most important takeaway is that violence against women is preventable. Addressing stalking not only improves women’s safety and mental health but could also reduce the long-term burden of heart disease and stroke.
Dr. Lawn stressed:
“Violence against women is common, but it is also preventable. The health impacts—decades later—are huge. We need a broader lens to understand and address these risks.”
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Raising Awareness and Providing Resources
The study underscores the need for both public awareness and policy interventions:
- Awareness Campaigns: To educate communities that stalking is not harmless, but a serious health issue.
- Support Services: Expanding access to shelters, hotlines, and counseling for women facing harassment.
- Stronger Legal Protections: Ensuring restraining orders are enforced effectively.
- Training for Healthcare Providers: To identify victims of stalking and provide holistic support.
The Harvard and UBC-led study provides one of the strongest pieces of evidence yet that stalking is not just a psychological burden—it is a cardiovascular risk factor.
Women who are stalked or forced to seek restraining orders face a significantly higher likelihood of developing heart disease and stroke, risks that persist even after accounting for lifestyle or genetic factors.
By recognizing stalking as a form of violence with real, measurable health consequences, researchers hope to shift medical practice, public policy, and community awareness.
At its core, the message is clear:
- Stalking is serious.
- Its health consequences are long-lasting.
- Preventing violence can save lives—not only by protecting women’s safety but also by safeguarding their hearts.
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