Abstract
BackgroundA growing body of evidence suggests that psychological stress contributes to coronary artery disease. However, associations between stress and stroke are less clear. In this study, we investigated the possible association between ischemic stroke and self-perceived psychological stress, as measured by a single-item questionnaire, previously reported to be associated with myocardial infarction.MethodsIn the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), 600 consecutive patients with acute ischemic stroke (aged 18 to 69 years) and 600 age-matched and sex-matched population controls were recruited. Ischemic stroke subtype was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Self-perceived psychological stress preceding stroke was assessed retrospectively using a single-item questionnaire.ResultsPermanent self-perceived psychological stress during the last year or longer was independently associated with overall ischemic stroke (multivariate adjusted odds ratio (OR) 3.49, 95% confidence interval (CI) 2.06 to 5.93). Analyses by stroke subtype showed that this association was present for large vessel disease (OR 3.91, 95% CI 1.58 to 9.67), small vessel disease (OR 3.20, 95% CI 1.64 to 6.24), and cryptogenic stroke (OR 4.03, 95% CI 2.34 to 6.95), but not for cardioembolic stroke (OR 1.48, 95% CI 0.64 to 3.39).ConclusionIn this case-control study, we found an independent association between self-perceived psychological stress and ischemic stroke. A novel finding was that this association differed by ischemic stroke subtype. Our results emphasize the need for further prospective studies addressing the potential role for psychological stress as a risk factor for ischemic stroke. In such studies ischemic stroke subtypes should be taken into consideration.
Highlights
A growing body of evidence suggests that psychological stress contributes to coronary artery disease
Using data collected in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) [22], a case-control study including ischemic stroke patients with careful phenotyping pertaining to stroke subtypes, we investigated self-perceived psychological as measured by the single-item previously reported to be associated with myocardial infarction in INTERHEART [6], in relation to ischemic stroke, the four major stroke subtypes, and functional outcome after 3 months
We found an independent association between acute ischemic stroke and self-perceived psychological stress as measured by a single-item questionnaire previously reported to be associated with myocardial infarction [6]
Summary
A growing body of evidence suggests that psychological stress contributes to coronary artery disease. In the INTERHEART study [6], a large case-control study with participants from 52 countries, the subjective perception of psychological stress was measured using a semiquantitative single item question. This simple measure showed a strong correlation to other constructs measuring various aspects of stress, including financial stress, stressful life events, and locus of control [6]. A few prospective and case-control studies have reported severe self-perceived psychological stress, various stressful life events, and failure to find successful strategies in stressful situations to be independently associated with an increased risk of stroke [11,12,13,14,15,16]. In this study the association was confined to women, whereas another study found an association only in men [20]
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