Cardiovascular Health and Social Hierarchy

Newman and colleagues (2011) found that younger individuals were more likely to have ischemic heart disease (IHD) within 10 years of follow-up from their baseline interview where trained nurses made observations for hostility. Although no explanation is provided in the article, as a millennial who is approaching the age range of participants in the study (~30-70 years), it seems a bit concerning that being younger could be indicative of increased risk for IHD. It also seems very confusing to think that a young adult would be at greater risk for a health issue at all. Aren’t we supposed to be the healthy ones that worry about the health of vulnerable populations like children and the elderly?

Sapolsky (1994) provides a potential explanation with his discussion of previous studies that found atherosclerosis (plaque that develops from platelets and “crud” in the circulatory system) in monkeys who were at the bottom of the social dominance hierarchy. Although Sapolsky does not address young adults specifically, it seems very feasible that young adults would experience cardiovascular and circulatory issues due to lack of social dominance. After all, young adults are typically at the bottom of the totem pole in their workplace, and therefore may be working toward objectives that a boss or supervisor has set forth. Young adults are also coming into a world and society where the pervasive culture has been created by generations before us. Additionally, it can be understandable in this day and age to consider whether young adults simply feel down on their luck. Most young adults have concerns that their parents and grandparents did not have- everything from massive student loans and fear of never being able to afford a home, to trying to solve the impending environmental crises for our generation and others to come.

Although Sapolsky provides a possible legitimate reason for the findings in the Newman and colleagues study, there’s still a gap that is missing. Is the fact that there is a difference in rates of IHD in age groups indicative that younger adults are always at higher risk, but then learn health tactics as they become older that prevent further damage? Or is it that younger people are becoming more hostile throughout generations, and therefore more likely to have IHD?

The study does not account for some of the confounding factors that could lead to cardiovascular disease, as was mentioned in Whooley and Wong’s (2011) editorial comment. One of these potential confounding factors is particularly noteworthy in consideration of incidents of IHD over generations- obesity. Two-thirds of Americans are now overweight or obese, and this rate has increased three-fold since the 1970s. This means that it is possible that the impact of obesity at a younger age may have impacted risk for IHD in the younger sample of this study in a way that it did not impact the older generations when they were younger. Because of this confound, it is actually possible that both generations may have experienced negative cardiovascular effects of being low on the totem pole in society as a young adult. However, because the younger group may have a higher rate of obesity than the older group, the effect of obesity and hostility on cardiovascular disease accumulated in such a way that was more detrimental than for older participants. If this is truly the case, it would be very concerning indeed, and possibly mean that the younger group of participants would likely suffer fatalities or excessive cardiovascular damage when they reach the age of the older participants at a higher rate than we currently see in the older participants in this study.


Newman, J. D., Davidson, K. W., Shaffer, J. A., Schwartz, J. E., Chaplin, W., Kirkland, S., & Shimbo, D. (2011). Observed hostility and the risk of incident ischemic heart disease: A prospective population study from the 1995 canadian nova scotia health survey. Journal of the American College of Cardiology, 58(12), 1222. doi:10.1016/j.jacc.2011.04.044

Sapolsky, R. M. (1994). Why zebras don’t get ulcers: A guide to stress, stress related diseases, and coping. New York: W.H. Freeman.

Whooley, M. A., & Wong, J. (2011). Hostility and cardiovascular disease. Journal of the American College of Cardiology, 58(12), 1229. doi:10.1016/j.jacc.2011.06.018




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