In a groundbreaking longitudinal study published in the American Heart Association’s flagship journal Circulation, researchers have uncovered a profound and troubling connection between experiences of stalking or the legal pursuit of restraining orders and the heightened risk of cardiovascular events in women. This pioneering investigation leveraged data from the Nurses’ Health Study II, a large-scale prospective analysis focusing on cardiovascular outcomes over a span of two decades. The study reveals that women who reported being stalked or had obtained restraining orders against offenders exhibited significantly increased incidences of heart attacks and strokes compared to their counterparts with no such experiences.
Stalking, often dismissed as a non-physical form of violence, emerges from this research as a potent and chronic stressor with serious physiological consequences. The study’s lead author, Dr. Rebecca B. Lawn, underscores the importance of expanding cardiovascular risk assessment frameworks beyond traditional factors to include underexplored trauma-related exposures. The work challenges prevailing clinical practices by highlighting how psychological and emotional stressors—specifically those related to intimate partner violence and stalking—may catalyze long-term vascular pathology.
Data were drawn from over 66,000 female registered nurses, predominantly non-Hispanic white, aged between 36 and 56 at the beginning of the study in 2001. None exhibited cardiovascular disease at baseline, enabling a clear prospective evaluation of new-onset events correlated with self-reported histories of stalking and securing restraining orders. Around 12% disclosed past stalking experiences, and roughly 6% reported having legally restricted contact through restraining orders, markers considered indicative of severe interpersonal violence.
Strikingly, the analysis quantified a 41% increase in the likelihood of cardiovascular disease among those reporting stalking victimization, while women who obtained restraining orders showed an even more pronounced 70% increase in risk. These associations persisted after adjustment for a comprehensive array of confounding risk factors, including lifestyle behaviors, medical comorbidities, psychological conditions such as depression, and even childhood abuse histories. Such resilience of effect underscores a robust link that transcends conventional cardiovascular risk paradigms.
The biological underpinnings of this relationship appear to be multifactorial and complex. Central to the hypothesis is the concept of chronic psychological distress precipitated by stalking, which may induce dysregulation of the autonomic nervous system. This disruption could impair endothelial function, promote inflammatory pathways, and disturb neurohormonal balance, all pivotal contributors to atherogenesis and thrombosis. Although this study did not delve into mechanistic experimentation, it lays an important foundation for future work to unravel these physiological cascades in detail.
The clinical implications are profound, given that stalking and violence against women are frequently overlooked in healthcare settings as silent contributors to cardiometabolic disease. Dr. Lawn emphasizes that stalking’s chronicity and invasive nature, involving unsolicited contact and a pervasive sense of fear, may compel victims to enact life-altering behavioral changes such as relocation—factors that can magnify stress and compound health risks. Yet, despite its insidious impact, stalking remains rarely measured or addressed as a cardiovascular risk factor in routine medical evaluations.
Expert commentary from Dr. Harmony R. Reynolds, a cardiologist specializing in women’s health and stroke, further contextualizes the significance of the findings. Dr. Reynolds notes that while psychosocial stressors have long been acknowledged as contributors to heart disease, this study’s demonstration of a long-term prospective effect specifically linking stalking and cardiovascular outcomes is novel and somewhat unexpected. She highlights the importance of social support networks in buffering stress, signifying potential avenues for intervention.
The research also prompts a broader reevaluation of how intimate partner violence and related forms of trauma intersect with cardiovascular health. Prior studies have identified associations between sexual assault, workplace harassment, and elevated hypertension risk in women. Adding stalking into this continuum expands the spectrum of violence-related health determinants that merit clinical and public health attention. It points to an urgent need for healthcare providers to incorporate trauma-informed approaches when assessing cardiovascular risks, particularly in female patients.
Despite its strengths, including a large sample size and comprehensive follow-up period, the study acknowledges certain limitations. The cohort’s lack of racial and socioeconomic diversity raises questions about generalizability to populations disproportionately impacted by violence. Additionally, reliance on self-reported data for stalking and restraining orders introduces the potential for underreporting or misclassification bias. The nuanced experiences of diverse racial and ethnic groups, as well as low-income populations, warrant further dedicated investigation.
Going forward, the research team advocates for enhanced training for healthcare professionals to recognize and address violence as a modifiable determinant of cardiovascular health. They stress the necessity of raising public awareness about the cardiovascular consequences of stalking and related abuse. Comprehensive support services and interventions aimed at mitigating psychological trauma may serve a dual purpose in improving both mental health and cardiovascular outcomes in vulnerable women.
This study represents a critical step in bridging gaps between social determinants of health, psychological well-being, and cardiovascular disease—a triad often siloed in clinical practice and research. By illuminating stalking as not merely a criminal justice issue but a potent cardiovascular risk factor, the findings call for an interdisciplinary response uniting cardiology, mental health, and social services to holistically support women’s health across the lifespan.
Ultimately, as heart disease remains the leading cause of death worldwide, this research imposes a new imperative for clinicians and policymakers alike: to recognize the hidden cardiovascular toll of interpersonal violence and integrate this understanding into prevention, screening, and treatment strategies. The Nurses’ Health Study II cohort offers compelling evidence that the scars of stalking and legal attempts at protection are not solely psychological but cascade into tangible, life-threatening physical health effects over decades.
Subject of Research: The association between experiences of stalking or obtaining restraining orders and the onset of cardiovascular events in women.
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: August 11, 2025
Web References:
