Self-reported stress linked with fatal stroke

July 1, 1993

Self-reported stress linked with fatal stroke

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DALLAS—People who said they were highly stressed had a higher risk of fatal stroke than people who said they were stress-free, according to a report in a recent rapid access issue of Stroke: Journal of the American Heart Association.

Researchers say the link may be due to the stressed people having cardiovascular risk factors. They tended to smoke, be less physically active, drink more alcohol and be treated for high blood pressure.

Because stress was associated with so many unhealthy behaviors, researchers couldn’t determine if self-reported stress was an independent risk factor.

People who said they had high stress levels had almost double the risk of fatal stroke. Those who said they felt stress on a weekly basis had a 50 percent increased risk of a fatal stroke compared to those in the least-stressed groups. Researchers found no significant effect of stress on nonfatal strokes.

There are several possible explanations why stress may be associated with only a higher risk of fatal stroke, says the study’s lead author, Thomas Truelsen, M.D., Ph.D., from the department of neurology, Bispebjerg Hospital and the Institute of Preventive Medicine, Copenhagen, Denmark.

“This group of stroke patients may have more severe strokes, have a more complicated rehabilitation period, or some unknown biological mechanism may be important,” Truelson said.

Researchers used data from The Copenhagen City Heart Study (CCHS), a prospective study examining 5,604 men and 6,970 women. From 1981 to 1983, participants were asked about the intensity and frequency of their stress. They were asked to report their stress intensity as never/hardly ever, light, moderate or high. They were asked to report their stress frequency as never/hardly ever, monthly, weekly or daily. Stress was defined as the sensation of tension, nervousness, impatience, anxiety or sleeplessness.

Truelsen says the questions reflected chronic stress rather than acute stress situations.

In 13 years of follow-up, 929 of all participants had a first-ever stroke; 207 (22 percent) were fatal within 28 days of onset. Of the 716 people who reported high stress, 59 (8 percent) had strokes. Eighteen people (2.5 percent) who reported high stress had fatal strokes. Researchers found that the risk of fatal stroke was 89 percent higher for those who reported a high level of stress compared to those who reported never or hardly ever having stress.

Truelsen suggests looking beyond stress to reduce fatal stroke risk.

“Both the person feeling stressed and the physician being consulted should try not only to discuss stress but also stroke risk factors and what can be done to reduce them,” he says.

“Lay people often mention stress as one of the most important risk factors for stroke, often before well-established stroke risk factors such as hypertension and smoking,” he says. “The scientific literature is inconclusive. Although stress is often mentioned, there is little agreement on what it actually means or how it should be measured.”

Co-authors are Naja Nielsen, B.Msc.; Gudrun Boysen, M.D., D.M.Sc.; and Morten Gronbaek, M.D., D.M.Sc.

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