Stroke Risk Rises with High Stress, Hostility, and Depression

Middle-age and older adults with higher levels of stress, hostility, and depressive symptoms are significantly more likely to have a stroke or transient ischemic attack (TIA), according to a new study in the journal Stroke.

“Chronic stress and negative emotions are important psychological factors that affect one’s health, and findings from this study link these factors to brain health in particular,” says lead study author Susan Everson-Rose, PhD, MPH, associate professor of medicine and associate director of the Program in Health Disparities Research at the University of Minnesota in Minneapolis.
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Everson-Rose and her colleagues analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing study conducted in 6 US cities that looks at cardiovascular disease risk factors. This racially and ethnically diverse population sample included 6,749 adults (53% women), ages 45 to 84, who were free of clinical cardiovascular disease at baseline.

These participants completed questionnaires that assessed their levels of chronic stress, depressive symptoms, anger, and hostility over the course of 2 years. During the follow-up period of an additional 8.5 to 11 years, 195 incident events occurred—147 strokes and 48 TIAs.

In comparison to their peers with the lowest psychological scores, those with the highest scores were:

• 86% more likely to have a stroke or TIA with high depressive symptoms.

• 59% more likely to have a stroke or TIA with the highest chronic stress scores.

• More than twice as likely to have a stroke or TIA with the highest hostility scores.

The researchers did not find an association between anger and significant increase in risk for stroke or TIA.

“Patients and their health care providers should be aware that experiences of chronic stress and negative emotional states can increase risk for stroke,” Everson-Rose says. “In addition to recognizing classic risk factors, such as smoking and high blood pressure, and how they contribute to poorer health outcomes, people need to pay attention to stress and emotions and how they affect health.”

Even when the researchers accounted for age, race, sex, health behaviors, and other known risk factors of stroke, the associations were significant.

“These results are independent of known stroke factors, (so) what is the pathway that links these psychological factors with stroke risk? This is an important topic for future studies,” Everson-Rose says.

In addition, she and her colleagues hope to conduct future research looking at how positive coping strategies for depressive symptoms, stress, or hostility could affect the link to stroke risk.

—Colleen Mullarkey

Reference

Everson-Rose SA, Roetker NS, Lutsey PL, Kershaw KN, Longstreth WT, Sacco RL, et al. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the Multi-Ethnic Study of Atherosclerosis. Stroke. 2014Jul 10; pii: STROKEAHA.114.004815. [Epub ahead of print].