By Crystal Phend, MedPage Today | Reviewed by Zalman S. Agus, MD/ everydayhaealth.com
Chronic stress from major life events and type A personality traits appears to substantially boost stroke risk, Spanish researchers found.
An intermediate to high score for stressful events like divorce, death in the family, or bankruptcy in the prior year nearly quadrupled the risk of a stroke in a case-control study by Jose Antonio Egido, MD, of the Hospital Clinico Universitario San Carlos in Madrid, and colleagues.
Individuals fitting the competitive, impatient type A personality pattern were 2.23 times more likely to have a stroke, the group reported online in the Journal of Neurology, Neurosurgery & Psychiatry.
These findings were independent of conventional stroke risk factors and unhealthy lifestyle, they noted.
“Addressing the influence of psychophysical factors on stroke could constitute an additional therapeutic line in the primary prevention of stroke in the at-risk population and, as such, warrants further investigation,” they wrote.
Because chronic stress has also been linked to cardiovascular disease, Egido’s group looked for a link to stroke in 150 stroke cases seen at a single hospital stroke unit and 300 of their healthy neighbors recruited from the census registry.
These groups of working-age adults in Madrid (range 18 to 65, mean 54) were compared from 2008, the beginning of a period of financial downturn when the housing market in that country collapsed, through 2010.
The strongest risk factor in the multivariate analysis was stressful life events over the prior year. The odds of stroke were 3.84 times higher for individuals with a score over 150 on the Holmes & Rahe questionnaire than for those with lower life stressor scores.
For perspective, death of a spouse equals 100 points on that scale; 150 to 300 is considered intermediate risk with a 50 percent probability of suffering illness related to the stress in the near future.
Those with signs of depression, as measured on the General Health Questionnaire 28 psychosocial subscale, were 22 percent more likely to have a stroke as well, but that association didn’t reach statistical significance.
“The level of distress and the depression symptoms associated with stress have somatic repercussions such as hypertension and are also associated with poor lifestyle choices such as low physical activity, tobacco habit, alcoholism and poor dietary habits,” Egido’s group pointed out.
However, tobacco, alcohol, gender, and physical activity levels didn’t appear to account for the stroke risk from stressful life events or from type A personality-related stress.
The researchers cautioned that their study excluded stroke patients who couldn’t respond on their own to the questionnaire, because proxy responses didn’t correlate well with patients’ own responses.
That exclusion of more severe or fatal cases may have minimized the association with stress, they noted.
Patient’s recall of stress in the prior year may have been biased by the stress of the stroke itself as may lifestyle factors, they added.