Psychosocial Stress Increases Acute Stroke Risk

Self-reported psychosocial stress has been reported to be an independent risk factor for stroke and myocardial infarction. Therefore, some cardiovascular disease prevention guidelines recommend screening for psychosocial stress in high-risk patients.

Long-term exposure to increased stress has been associated with the development of atherosclerosis and small vessel disease (i.e., intermediate phenotype), and short-term increases in stress have been reported to trigger acute cardiovascular events. The strength of the association of chronic stress exposure with cardiovascular disease that has been reported in prospective cohort studies has generally been lower than the association of short-term increases in stress with the triggering of cardiovascular events that has been reported. in case studies. control studies.

Although there is reasonable consensus that psychosocial stress is a risk factor for stroke, no convincing intervention has been shown to reduce both stress and stroke risk. Consequently, there is debate about the rationale for investing in public health interventions to address stress management and prevention. Although stress exposure may have limited modifiability for many people and situations, there may be other opportunities to mitigate the association of stress and cardiovascular risk, such as improving coping strategies or environmental factors to mitigate the impact of stress (place of control ), which can be an important effect modifier.

The INTERSTROKE study offers the opportunity to evaluate the association of recent exposure to psychosocial stress (i.e., past year) with stroke risk in an international population. INTERSTROKE investigators have previously reported on the association between global psychosocial stress and stroke, reporting an increased risk of stroke associated with global psychosocial stress.

The objective of the present analysis of the INTERSTROKE study was to evaluate the associations of different psychosocial stressors with the risk of stroke in different populations (characterized by age, sex, region and self-reported ethnicity) and to consider whether factors such as locus of control are associated with risk. modified.

Importance  

Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population health interventions.

Goals  

To determine the association of psychosocial stress with the risk of acute stroke and explore factors that could modify the association of stress with the risk of acute stroke in a large international population.

Design, environment and participants  

INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East and Africa. A total of 13,462 stroke patients and 13,488 matched controls were recruited between January 11, 2007 and August 8, 2015. The present analyzes were conducted from June 1 to June 30, 2021, and included 13,350 cases and 13,462 controls with available data on psychosocial stress.

Exhibitions  

Psychosocial stress and the occurrence of stressful life events in the previous year were measured using a standardized self-reported stress questionnaire at home and at work.

Main results and measures  

The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that could modify the association, particularly self-reported locus of control.

Results 

Among the 26,812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Various periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0 %] among controls and 364 of 3980 [9.1%] among cases) and the highest in Southeast Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among the cases).

Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25- 3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke in multivariable analyzes (vs. no self-reported stress). .P = 0.008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < 0.001 for interaction) for acute stroke.

Discussion

Findings from this international case-control study suggest an association between psychosocial stress and stressful life events with an increased risk of all strokes. This association is consistent for ischemic and hemorrhagic stroke types. Our findings suggest that the association between stress and stroke is consistent across all age groups and geographic regions, with the possible exception of Africa.

Locus of control and its relevant components, life control and work control, appear to be important effect modifiers . The association between locus of control and stroke appears to be contextual (e.g., job control appears to modify the effect size of job stress on stroke risk). Locus of control warrants further evaluation as a potential target for public health interventions.