Women who experience prolonged stalking—whether by a partner or another individual—face a significantly higher risk of cardiovascular disease, according to a large U.S. study published in Circulation.
The research tracked over 66,000 women for two decades. Those reporting stalking—a repeated, unwanted form of harassment—were 41% more likely to develop heart disease or suffer a stroke than women who had not been stalked. Among women who obtained restraining orders, the risk jumped to 70%.
“Many people don’t perceive stalking as a severe experience because it often lacks physical contact,” said lead researcher Prof. Karsten Kounen, a professor of psychiatric epidemiology at Harvard University. “But it has deep psychological effects that can also impact physical health. Common non-physical forms of violence against women are health hazards and should be taken as seriously as smoking or poor nutrition.”
Dr. Iran Kruchin, senior cardiologist at Clalit Health Services in Tel Aviv, explained that chronic mental stress increases inflammation and accelerates atherosclerosis—major contributors to heart disease and stroke. Acute stress can trigger coronary artery constriction, sometimes resulting in a heart attack, a phenomenon known as “broken heart syndrome.” Stress can also raise heart rate, blood pressure, and cholesterol levels, and exacerbate existing heart conditions.
Dr. Iran KruchinDr. Ofer Grosbard, a clinical psychologist at Maccabi Healthcare, emphasized the physical toll: “When someone lives under constant threat for months or years, their body reacts as if it is in a perpetual state of emergency. The fight-or-flight mechanism is repeatedly activated, increasing pulse, blood pressure, and levels of adrenaline and cortisol. This chronic stress wears down the heart and blood vessels, raising clotting risks and significantly increasing the chance of heart attack and stroke. Stalking kills—not just emotionally but physically.”
Stalking behaviors include surveillance, unwanted appearances, and online harassment. Despite its prevalence—one in three women in the U.S. and roughly 18.5% of women in the EU experience stalking—medical research on its physical impact has been limited.
Data for the study came from a long-term survey of U.S. nurses, initially conducted in 2001, who were followed for 20 years. None had heart disease at the study’s start. About 12% reported experiencing stalking, and 6% had obtained restraining orders. During the follow-up period, roughly 3% developed heart disease or suffered a stroke, but rates were significantly higher among stalking victims.
Experts highlight the importance of addressing psychological stress through mental health support, physical activity, and stress-reduction techniques as part of cardiovascular care. Emotional support during cardiac rehabilitation can shorten recovery times and reduce the risk of recurrent events.
The study’s participants were predominantly white women, and researchers caution that the findings may not fully represent all populations. Prior studies indicate women from ethnic minorities or lower socioeconomic backgrounds may be at even greater risk. Researchers call for urgent improvements in how healthcare systems respond to stalking, both for physical and mental health outcomes.