Even without physical contact, stalking can leave scars that reach the heart. A new 20-year study from Harvard T.H. Chan School of Public Health finds that women who have been stalked face a 41% higher risk of cardiovascular disease, while those who obtained a restraining order face a 70% higher risk. Published August 11 in Circulation, the research is the first to directly link stalking to long-term heart health outcomes.
Tracking Violence and Heart Health Over Two Decades
The findings draw on data from 66,270 participants in the Nurses’ Health Study II, all free of cardiovascular disease at baseline in 2001. Researchers followed them through 2021, documenting self-reported and medically confirmed cases of heart attack or stroke. Nearly 12% of women reported having been stalked, and 5.6% reported obtaining a restraining order, often in response to severe violence.
- Women stalked at any point in life had a 41% higher risk of developing cardiovascular disease (hazard ratio [HR] 1.41, 95% CI 1.24–1.60).
- Women who obtained a restraining order had a 70% higher risk (HR 1.70, 95% CI 1.44–1.98).
- The highest risk was among women who experienced both, with more than double the risk compared to women with neither experience.
Psychological Violence, Physical Impact
Lead author Rebecca B. Lawn, who conducted the research as a postdoctoral fellow at Harvard Chan School, notes that stalking, often dismissed as non-serious, can have profound physical consequences. Senior author Karestan Koenen emphasized, “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.”
Mechanisms may include psychological distress that disrupts the nervous system, damages blood vessel function, and triggers harmful biological processes. The study controlled for traditional risk factors such as smoking, diet, physical activity, and body mass index, as well as childhood abuse and depressive symptoms. Even with these adjustments, the associations remained significant.
Beyond Physical Assault
While past research has focused on physical or sexual violence, stalking, affecting nearly one in three U.S. women at some point, remains understudied. This work underscores that threats, harassment, and other persistent unwanted attention can be as damaging to cardiovascular health as more visible forms of abuse.
“In health care settings, we need to improve screening for stalking and other forms of violence and provide resources for women to protect themselves,” said Koenen. “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.”
Implications for Health Care and Policy
The authors call for stalking and restraining order history to be integrated into cardiovascular risk assessments. Public health interventions could use legal interactions, such as restraining order filings, as opportunities to connect women with preventive health services and mental health support.
Given the chronic stress stalking can create, and its average duration of nearly two years, the researchers say the cardiovascular consequences should be treated with the same urgency as traditional risk factors. The study adds to a growing body of evidence that psychological violence can have lasting impacts on physical health.
Study Details
Journal: Circulation (August 11, 2025)
DOI: 10.1161/CIRCULATIONAHA.124.073592
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