Objective:

To investigate the association between adulthood stressful life events (SLEs) and the risk of heart disease across different countries (China, the United States, and the United Kingdom) and to assess the dose-response relationship.

Key Findings:

• At least one SLE was associated with a higher risk of incident heart disease: adjusted HR 1.20 (95% CI 1.09–1.31) in CHARLS, 1.23 (95% CI 1.11–1.36) in HRS, and 1.53 (95% CI 1.27–1.85) in ELSA.
• Risk increased across SLE-count categories in HRS and ELSA, but not clearly in CHARLS for ≥3 events.
• Associations were attenuated when excluding health- and injury-related items, particularly in HRS and ELSA.
• Effect modification was observed in HRS, with stronger associations in women and participants without hypertension or diabetes.

Interpretation:

The study provides cross-national evidence that adulthood SLEs are linked to a small-to-moderate increase in heart disease risk, although the strength of this association varies by cohort.

Limitations:

• Heterogeneity in the measurement of SLEs across cohorts may affect comparability.
• Potential confounding factors (e.g., socioeconomic status, lifestyle factors) not accounted for in the analysis.
• Limited generalizability due to the specific populations studied.

Conclusion:

Adulthood SLEs are associated with increased heart disease risk, supporting the need for stress assessment in cardiovascular prevention strategies.