Stalking, obtaining restraining order linked with increased cardiovascular disease risk in women

Embargoed for release: Monday, August 11, 5:00 AM ET

Key points:

• In a 20-year study, women with experience being stalked had a 41% higher risk of cardiovascular disease (CVD) than women without this experience. Women with experience obtaining a restraining order—typically indicative of severe violence—had a 70% higher risk of CVD than women without that experience.
• Prior studies have not looked at the relationship between women’s experiences with stalking and CVD outcomes, and few have investigated the link between physical health outcomes and psychological violence commonly faced by women.
• According to the researchers, the findings highlight the need to consider women’s experiences with violence as legitimate health determinants.

Boston, MA—Women with experience being stalked and/or who have experience obtaining a restraining order were significantly more likely to develop cardiovascular disease (CVD) than women without these experiences, according to a new study led by researchers at Harvard T.H. Chan School of Public Health.

“To many people, stalking doesn’t seem to be such a serious experience, as it often does not involve physical contact. But stalking has profound psychological consequences that can have physical implications,” said senior author Karestan Koenen, professor of psychiatric epidemiology. “Our study highlights that these preventable, common, non-contact forms of violence against women are health hazards and need to be considered as such, just like we consider smoking or poor diet.”

The study will be published August 11 in Circulation.

While previous research has established violence as a risk factor for CVD, most of these studies have focused on physical forms of violence. Very few have investigated the link between physical health outcomes and psychological violence commonly faced by women, including stalking, and none to date have specifically examined the link between CVD and stalking. The U.S. Centers for Disease Control and Prevention has estimated that about one in three women have been stalked at some point in their lives, most often by an intimate partner or an acquaintance.

The researchers followed the CVD outcomes of a group of 66,270 women, ages 36-56, enrolled in the Nurses’ Health Study II between 2001 and 2021. Participants who reported any incidences of CVD, defined as heart attack or stroke, were excluded. The results showed 7,721 (11.7%) reported experience with stalking, and 3,686 (5.6%) reported experience with obtaining a restraining order. By the end of the study period, 1,879 of the women (2.8%) reported incidence of CVD. When estimating the impact of stalking and/or restraining order history on CVD risk, the researchers controlled for other health factors, such as parental CVD history.

The study found that the risk of CVD was 41% higher in women who experienced stalking and 70% higher in women with experience obtaining a restraining order, compared to women without these experiences. The researchers also observed a dose-response relationship whereby women who reported both an experience with stalking and an experience obtaining a restraining order had the highest elevated risk of CVD.

The link between stalking and cardiovascular disease may be due to psychological distress, which may disrupt the nervous system, impair proper blood vessel function, and negatively affect other biological mechanisms, the authors noted.

“Our findings indicate that, to better mitigate women’s risk of CVD, more attention needs to be paid to their experiences of violence,” Koenen said. “In health care settings, we need to improve screening for stalking and other forms of violence and provide resources for women to protect themselves. And zooming out further, on a broad public health level, we need to do better in addressing and preventing the root causes of violence against women.”

Corresponding author Rebecca Lawn led the study while a postdoctoral research fellow at Harvard Chan School. Other Harvard Chan authors included Audrey Murchland, Camille Marquez, and Laura Kubzansky.

The study was supported by the National Institutes of Health (grants U01CA176726, K24HL123565, K23HL159293), the National Institute of Mental Health (grant R01 MH101269) the National Institute on Aging (grant F31AG080869), and the Broad Trauma Initiative at the Broad Institute of MIT and Harvard.

“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,” Rebecca B. Lawn, Audrey R. Murchland, Rebecca C. Thurston, Camille Marquez, Karen Jakubowski, Laura Sampson, Jennifer A. Sumner, Laura D. Kubzansky, Karestan C. Koenen, Circulation, August 11, 2025, doi: 10.1161/CIRCULATIONAHA.124.073592 

Visit the Harvard Chan School website for the latest news and events from our Studio.

###

Harvard T.H. Chan School of Public Health is a community of innovative scientists, practitioners, educators, and students dedicated to improving health and advancing equity so all people can thrive. We research the many factors influencing health and collaborate widely to translate those insights into policies, programs, and practices that prevent disease and promote well-being for people around the world. We also educate thousands of public health leaders a year through our degree programs, postdoctoral training, fellowships, and continuing education courses. Founded in 1913 as America’s first professional training program in public health, the School continues to have an extraordinary impact in fields ranging from infectious disease to environmental justice to health systems and beyond.