A study appearing in the American Heart Association journal Stroke links higher levels of stress, hostility, and depressive symptoms to a significantly increased risk of stroke or transient ischemic attack (TIA) in middle-age and older adults. During the study, researchers reportedly used data from the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing study centered on cardiovascular disease risk factors in participants living in six US cities.

The researchers investigated how psychological factors might influence risk for chronic disease. A news release issued by the American Heart Association notes that more than 6,700 adults aged 45 to 84 years old, and 53% of whom were women, completed questionnaires designed to assess chronic stress, depressive symptoms, anger, and hostility for a duration of 2 years. All participants were free of cardiovascular disease at the start of the study.

In follow-up for an additional 8.5 to 11 years, the release says, 147 strokes and 48 TIAs occurred.

The release notes that researchers measured chronic stress in five domains that included personal health issues, health issues of others close to the participant, job or ability to work, as well as relationships, and finances. Depressive symptoms were assessed with a 20-question scale and analyzed anger with a 10-item scale intended to capture the extent and frequency of experiencing that emotion. Hostility was measured by assessing an individual’s cynical expectations of others’ motives.

The study’s results suggest compared to individuals with the lowest psychological scores, individuals with the highest scores were 86% more likely to have a stroke or TIA for high depressive symptoms and 59% were more likely to sustain a stroke or TIA for the highest chronic stress scores. Additionally, the results indicate those with the highest psychological scores were also more than twice as likely to have a stroke or TIA for the highest hostility scores. The researchers add that no significant risk was linked to anger in the study.

Susan Everson-Rose, PhD, MPH, study lead author, and associate professor of medicine at the University of Minnesota, Minn, notes that while there was a focus on traditional risk factors such as cholesterol levels, blood pressure, and smoking, “studies like this one show that psychological characteristics are equally important.”

The release states that these associations remained significant, even when researchers accounted for age, race, sex, health behaviors, and other known risk factors for stroke.

Everson-Rose emphasizes the importance of the study’s findings, pointing out that given the aging population “it’s important to consider these other factors that might play a role in disease risk. Stroke is a disease of the elderly predominantly, and so learning more about things that can influence risk for stroke as people age is important.”

One component the study did not assess, Everson-Rose says, was coping strategies.

“If someone is experiencing depressive symptoms or feeling a lot of stress or hostility, we don’t know how they manage those, so it’s possible that positive coping strategies could ameliorate some of these associations or effects,” Everson-Rose explains.

Source(s): Eurekalert, American Heart Association