Psychosocial Stress Tied to Elevated Risk for Acute Stroke

Kelli Whitlock Burton

December 12, 2022

People with high stress levels have a significantly higher risk for acute stroke than their counterparts with low stress, but the risk lessens if they feel in control of work and home life, a new study suggests.

The benefit was greatest among those who believed they had more control at work, compared with those whose "locus of control" was higher at home.

The findings come from the INTERSTROKE study, an international case-control study of risk factors for first stroke.

"In those who reported severe work stress, the increase in risk was smaller in those who felt that they had high control over their work life compared to those who felt they had low control over their work life," lead investigator Catriona Reddin, MB, a doctoral student at the University of Galway, Galway. Ireland, and Irish Clinical Academic Training fellow, told Medscape Medical News.

The findings were published online December 9 in JAMA Network Open.

The Dangers of Stress

The INTERSTROKE study includes more than 25,000 stroke patients and controls from 32 countries who were enrolled between 2007 and 2015. The current research included data from 13,350 cases and 13,462 controls.

Each case was matched for sex and age with a control from the same center or catchment area. Cases comprised patients who presented with a first ischemic or hemorrhagic acute stroke and were enrolled within 72 hours of hospital admission or 5 days of symptom onset.

All participants completed a standardized questionnaire with questions designed to measure stress at home, work stress, financial stress, and stressful life events. Cases were asked to respond as they would have before their stroke.

More individuals with a history of stroke reported high levels of home stress compared with controls (14.2% vs 9.6%, respectively). After controlling for sex, age, and a host of other risk factors, high stress at home was associated with a significant increased risk for all stroke (adjusted odds ratio [aOR], 1.95; 95% CI, 1.77-2.15), ischemic stroke (aOR, 1.82; 95% CI, 1.63-2.03), and intracerebral hemorrhage (aOR, 2.55; 95% CI, 2.05-3.18).

High work stress was also reported more often in cases compared with controls (23.1% vs 15.4%, respectively) and was associated with a significant increase in risk for all stroke (aOR, 2.70; 95% CI, 2.25-3.23), ischemic stroke (aOR, 2.27; 95% CI, 1.85-2.78), and intracerebral hemorrhage (aOR, 5.20; 95% CI, 3.48-7.77).

"The association between stress and stroke remained significant after adjusting for cardiovascular risk factors such as hypertension and smoking, suggesting that the association may be independent of these cardiovascular risk factors," Reddin said.

Blunting the Risk

However, researchers found that feeling in control of work and home life could blunt the increased risk for stroke.

Although high stress levels were still tied to elevated stroke risk compared with low stress levels, that risk was smaller if they felt they had more control at work (OR, 2.20 vs 2.70; P = .008) and at home (OR, 1.69 vs 2.40; P < .001) compared with those with a low locus of control.

Stress is a known risk factor for cerebrovascular events and clinical guidelines include managing psychosocial stress to prevent stroke and coronary heart disease. But the ideal method for managing stress is unclear.

This new study suggests one way may be to alter working conditions to allow employees greater control over what happens on the job.

Commenting on the findings for Medscape Medical News, Mitchell Elkind, MD, chief clinical science officer at the American Heart Association, said the specific interventions could be implemented at the organizational level or by individual workers.

"The specific interventions probably depend on many factors, including the nature of the work and the environment of the workplace," Elkind said. "But in general, employers could help by giving employees greater control over their work hours, by allowing them to determine their work hours through flexible scheduling or giving them the chance to participate in decisions about the workplace and using problem-solving committees."

The study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart Lung Foundation, and others. See the original report for a full funding list. Reddin and Elkind reported no relevant financial conflicts.

JAMA Netw Open. Published online December 9, 2022. Full text.

Kelli Whitlock Burton is a reporter for Medscape Medical News covering neurology and psychiatry.

For more Medscape Neurology news, join us on Facebook and Twitter.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.