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In the Age of COVID: Psychosocial Stress and Risk of Acute Stroke

In the Age of COVID: Psychosocial Stress and Risk of Acute Stroke

Courtesy of Ken Pope, PhD:  JAMA Network Open provided a study: “Association of Psychosocial Stress With Risk of Acute Stroke.”  

Here’s how the article opens: Self-reported psychosocial stress has been reported to be an independent risk factor for stroke and myocardial infarction. Hence, some guidelines for cardiovascular disease prevention recommend screening for psychosocial stress in high-risk patients.

Long-term exposure to increased stress has been associated with development of atherosclerosis and small-vessel disease, and short-term increases in stress have been reported as a trigger for acute cardiovascular events.

The strength of the association of exposure to chronic stress 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 triggering cardiovascular events that has been reported in case-control studies.

Although reasonable consensus exists that psychosocial stress is a risk factor for stroke, no convincing interventions have been proven to reduce both stress and the risk of stroke. Consequently, there is debate about the logic of investing in public health interventions to target stress management and prevention. Although exposure to stress 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 enhancing coping strategies or environmental factors to mitigate the impact of stress (locus of control), which may be an important effect modifier.

The INTERSTROKE study offers an opportunity to evaluate the association of a recent exposure to psychosocial stress (i.e., the past year) with stroke risk in an international population.

The 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 aim 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 modified risk.

Here’s how the Discussion opens: Our study found that self-reported psychosocial stress within the previous 12 months was associated with increased risk of all stroke, ischemic stroke, and hemorrhagic stroke. This association was consistent for all stress domains, including work stress, home stress, and financial stress. 

The association was independent of socioeconomic status, occupation, and educational level and remained significant after adjustment for cardiovascular risk factors, suggesting that some of the association may be independent of other cardiovascular risk factors (e.g., blood pressure, smoking, unhealthy diet). 

We report that higher locus of control at work and home diminished the magnitude of association between context-specific psychosocial stress and odds of acute stroke.

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