Chronic stress, depressive symptoms, and hostility associated with increased risk of stroke

Thursday, July 10, 2014

Negative emotions are associated with significantly increased risk of stroke or transient ischemic attacks (TIAs, or mini strokes) in middle-aged and older adults, according to new research out of the University of Minnesota.

The results are published in the latest edition of the American Heart Association journal Stroke.

Utilizing data from the Multi-Ethnic Study of Atherosclerosis (MESA), Susan Everson-Rose, Ph.D., M.P.H., associate director of the Program in Health Disparities Research and associate professor of Medicine in the University of Minnesota Medical School, noted an association between negative emotions and increased stroke risk.

MESA is a national population-based study tracking health information and clinically verified medical events of more than 6,000 men and women from around the United States and includes whites, African Americans, Chinese and Hispanic participants. The study focuses specifically on risk factors related to cardiovascular disease in adults between 45 and 84 years of age.

Everson-Rose analyzed responses regarding chronic stress and negative emotions, including depressive symptoms, anger, and hostility, in relation to risk for stroke and TIA.

“There’s 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,” said Everson-Rose. 

Interestingly, the association between negative emotional factors and stroke appears to be independent of other known stroke risk factors such as smoking, high blood pressure and more. This indicates there likely is another pathway for these negative emotions to impact cardiovascular health, something suggesting more research is needed on the topic to understand the nature of the association.

Over the follow-up period of 8.5 years, 147 strokes and 48 TIAs were clinically verified among MESA participants. When comparing psychological responses among participants, those with high levels of negative emotions and stress were at a higher risk of having a stroke event.

Specifically, compared to those with low scores, participants with high scores were:

  • 86 percent more likely to have a stroke or TIA for high depressive symptoms.

  • 59 percent more likely to have a stroke or TIA for the highest chronic stress scores.

  • More than twice as likely to have a stroke or TIA for the highest hostility scores

But anger scores did not increase stroke risk.

Associations did not differ among racial groups or by age or sex.

The results have relevance for both clinicians and family members, as it encourages a closer look at the whole health picture even beyond just physical symptoms.

"Stroke is predominantly a disease of aging,” said Everson-Rose. “With our rapidly aging population, this reaffirms the necessity for attention to these independent factors.”

The Study was supported by NHLBI and NCRR grants N01-HC-95159 through N01-HC-95169, UL1-RR-024156 and UL1-RR-025005. Dr. Everson-Rose received support from N01-HC-95163, the Applied Clinical Research Program and Program in Health Disparities Research at the University of Minnesota.