Higher levels of stress, hostility and depressive symptoms are associated with significantly increased risk of stroke or transient ischemic attack in middle-age and older adults, according to new research.
The study was published July 10 in the American Heart Association journal Stroke.
Researchers investigated how psychological factors might influence risk for chronic disease, using data from the Multi-Ethnic Study of Atherosclerosis, an ongoing study on cardiovascular disease risk factors in participants living in six U.S. cities.
More than 6,700 adults ages 45-84 (53% women) completed questionnaires assessing chronic stress, depressive symptoms, anger and hostility for two years. Participants were 38.5% white, 27.8% African-American, 11.8% Chinese and 21.9% Hispanic. All were free of cardiovascular disease at the beginning of the study.
In follow-up for another 8.5 to 11 years, 147 strokes and 48 TIAs occurred.
Compared to people with the lowest psychological scores, those with highest scores were:
86% more likely to have a stroke or TIA if they had high depressive symptoms.
59% more likely to have a stroke or TIA if they had the highest chronic stress scores.
More than twice as likely to have a stroke or TIA if they had the highest hostility scores.
No significant increased risk was linked to anger.
Theres such a focus on traditional risk factors cholesterol levels, blood pressure, smoking and so forth and those are all very important, but studies like this one show that psychological characteristics are equally important, Susan Everson-Rose, PhD, MPH, study lead author and associate professor of medicine at the University of Minnesota in Minneapolis, said in a news release.
These associations noted in the study were significant even when researchers accounted for age, race, sex, health behaviors and other known risk factors of stroke.
Given our aging population, its important to consider these other factors that might play a role in disease risk, Everson-Rose said in the release. Stroke is a disease of the elderly predominantly, and so learning more about things that can influence risk for stroke as people age is important.
Researchers measured chronic stress in five domains: personal health problems, health problems of others close to the participant, job or ability to work, relationships and finances.
They assessed depressive symptoms with a 20-question scale and analyzed anger with a 10-item scale that captured the extent and frequency of experiencing that emotion. Hostility, which is a negative way of viewing the world, was measured by assessing a persons cynical expectations of other peoples motives.
One thing we didnt assess is coping strategies, Everson-Rose said in the release. If someone is experiencing depressive symptoms or feeling a lot of stress or hostility, we dont know how they manage those, so its possible that positive coping strategies could ameliorate some of these associations or effects.
She added coping would be a good focus for future studies.
Researchers didnt identify potential racial and ethnic differences or sex differences in the observed associations but were not able to fully examine such differences because of the smaller numbers of strokes in some groups.
The National Heart, Lung, and Blood Institute funded the study.