Anxiety Linked to Increased Stroke Risk

December 27, 2013

High anxiety levels were associated with an increased risk for incident stroke independent of other risk factors, including depression, in a new prospective study.

"Anxiety is a modifiable experience that is highly prevalent among the general population. Its assessment and treatment may contribute to developing more effective preventive and intervention strategies for improving overall cardiovascular health," the authors conclude.

The study, published online in Stroke on December 19, was conducted by a team led by Maya J. Lambiase, PhD, University of Pittsburgh School of Medicine, Pennsylvania.

"Everyone has some anxiety now and then. But when it's elevated and/or chronic, it may have an effect on your vasculature years down the road," Dr. Lambiase said.

For the study, the researchers tracked 6019 people 25 to 74 years who took part in the first National Health and Nutrition Examination Survey (NHANES I). At baseline the participants underwent an interview, blood tests, and medical examinations and completed psychological questionnaires to gauge anxiety and depression levels. They were then followed for an average of 16 years, during which time strokes were identified from hospital or nursing home records and death certificates.

A total of 419 incident stroke cases were identified. Results showed that reporting more anxiety symptoms at baseline was associated with an increased risk for incident stroke after adjustment for standard biological and behavioral cardiovascular risk factors.

Table. Risk for Incident Stroke With Increasing Anxiety Symptoms

Endpoint Hazard Ratio (95% Confidence Interval)
Anxiety (per 1–standard deviation increase) 1.14 (1.03 - 1.25)

Adjusted for age, sex, education, race, marital status, systolic blood pressure, diastolic blood pressure, blood pressure medication, cholesterol, diabetes, body mass index, alcohol, physical activity, and smoking.


Those in the highest tertile of anxiety symptoms had a 33% higher stroke risk than those in the lowest tertile. Findings persisted after additional adjustment for depression.

The researchers point out that this is the first study to link anxiety and stroke independent of other factors. They suggest that the mechanism may involve poor health behaviors, particularly smoking and low physical activity, which are common in people with anxiety.

However, even after adjustment for such behaviors, the association between anxiety and stroke remained, and the authors postulate that chronic anxiety could lead to excess activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system that may increase the risk for stroke.

Anxiety could also contribute to stroke or other cardiovascular disease by lowering the threshold for arrhythmia or by reducing heart rate variability.

The study was funded by the National Heart, Lung, and Blood Institute and the National Institute of Mental Health of the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Stroke. Published online December 19, 2013. Abstract


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