A groundbreaking longitudinal study led by researchers at Harvard T.H. Chan School of Public Health has revealed compelling evidence linking women’s experiences of stalking and the subsequent legal protection measures, such as restraining orders, to a significantly increased risk of developing cardiovascular disease (CVD). This extensive 20-year investigation tracked over 66,000 women, uncovering an association that may profoundly reshape how violence against women is understood in terms of long-term physical health impacts.
Historically, research into violence as a risk factor for CVD has predominantly concentrated on physical abuse, leaving psychological forms—especially stalking—largely unexplored. This study fills a vital gap by focusing specifically on stalking, a form of non-physical violence frequently dismissed or underestimated despite its pervasive nature. Psychological trauma, which stalking invariably entails, can trigger a cascade of biological responses that undermine cardiovascular health, elucidating mechanisms previously overlooked in the field.
The cohort comprised women aged 36 to 56 enrolled in the Nurses’ Health Study II, a robust epidemiological study designed to examine chronic disease correlates among female nurses. Importantly, participants with prior cardiovascular events such as heart attack or stroke were excluded to isolate incident cases of CVD. Approximately 11.7% of the women reported experiencing stalking, and 5.6% had obtained restraining orders, markers suggestive of escalating severity of exposure to violence or threat.
By the study’s conclusion in 2021, 2.8% of the participants had developed CVD, defined rigorously through incident myocardial infarction or stroke events verified in medical records. Statistical models controlling for confounding variables including parental CVD history and traditional risk factors revealed that women who had been stalked faced a 41% heightened risk of CVD. The risk was even more pronounced—70% greater—in those who had pursued restraining orders, indicating a correlation between violence intensity and cardiovascular risk.
The observed dose-response relationship further strengthens the causal inference: women reporting both stalking experiences and protective orders exhibited the highest cardiovascular risk profiles. This gradient effect implies that cumulative psychosocial stressors contribute additively to disease pathogenesis. Such findings suggest a paradigm shift is needed, whereby healthcare practitioners integrate violence screening and trauma-informed care into routine cardiovascular risk assessments.
Underlying biological mechanisms likely involve chronic psychological distress stemming from stalking, which can activate the autonomic nervous system dysregulation, disrupt endothelial function, and elevate systemic inflammation. These pathways destabilize vascular homeostasis, promote atherosclerotic processes, and impair cardiac function over time. The study highlights how stress-induced sympathetic overdrive and hypothalamic-pituitary-adrenal axis dysfunction serve as critical mediators linking psychological trauma to somatic disease states.
Conventional cardiovascular risk factors such as cigarette smoking, poor diet, and sedentary lifestyles have long dominated clinical prevention frameworks. However, this research urges the inclusion of violence-related psychological stress as a legitimate and measurable risk determinant. This broader biopsychosocial model acknowledges the social determinants of health and recognizes the insidious impact of psychological violence on somatic disease.
From a public health standpoint, these findings demand increased attention to violence prevention strategies that transcend immediate physical safety to encompass long-term health trajectories. Integrating mental health services, legal support, and social interventions could mitigate cardiovascular sequelae in survivors of stalking and intimate partner violence. At the policy level, investments in community education programs and reinforced enforcement of protective laws could indirectly reduce cardiovascular morbidity.
Clinicians are called to action to routinely screen for stalking and intimate partner violence in both primary care and cardiovascular specialty settings. Early identification offers a window for targeted interventions, including psychological counseling, pharmacological management of stress and anxiety, and cardiometabolic monitoring. This interdisciplinary approach could substantially attenuate the excess CVD risk borne by women subjected to chronic stalking.
Moreover, the study underscores the necessity for future research to unravel the nuanced interactions between psychological violence, genetic predisposition, and environmental stressors in cardiovascular pathology. Longitudinal biomarker studies and neuropsychological assessments could refine risk stratification and guide personalized therapeutics. Such work will be critical in advancing precision medicine that captures the full complexity of psychosocial contributors to heart disease.
In sum, the Harvard-led study compellingly establishes stalking and related legal measures as impactful factors in cardiovascular disease epidemiology among women. This challenges clinicians, researchers, and policymakers alike to reconceptualize violence not merely as a criminal justice issue but as an urgent public health concern with measurable physiological consequences. Addressing this link could transform prevention paradigms and ultimately improve cardiovascular outcomes in vulnerable populations.
Subject of Research: Not applicable
Article Title: Experiences of stalking and obtaining a restraining order are associated with onset of cardiovascular events in women: a prospective analysis in the Nurses’ Health Study II
News Publication Date: 11-Aug-2025
References:
Lawn RB, Murchland AR, Thurston RC, Marquez C, Jakubowski K, Sampson L, Sumner JA, Kubzansky LD, Koenen KC. Experiences of stalking and obtaining a restraining order are associated with onset of cardiovascular events in women: a prospective analysis in the Nurses’ Health Study II. Circulation. 2025 Aug 11. doi: 10.1161/CIRCULATIONAHA.124.073592
Keywords:
Cardiovascular disease, Myocardial infarction, Women’s studies, Feminism, Social issues, Social groups, Social conditions, Violence, Domestic violence, Human social behavior
