Recent research revealed that chronic stress may significantly increase the risk of cryptogenic ischemic stroke in young adults, particularly women.
In the study, in Neurology, investigators from Helsinki University Hospital and multiple European centers examined the relationship between self-perceived stress levels and cryptogenic ischemic stroke risk in individuals aged 18 to 49 years.
"Younger people often experience stress due to the demands and pressures associated with work, including long hours and job insecurity, as well as financial burdens," said senior study author Nicolas Martinez-Majander, MD, PhD, of the Helsinki University Hospital in an accompanying press release. "Previous research has shown that chronic stress can negatively affect physical and mental health. Our study found it may increase the risk of cryptogenic ischemic stroke in younger women," he added.
The investigators examined 426 individuals aged 18 to 49 years who had experienced cryptogenic ischemic stroke (strokes with no identifiable cause) and age- and sex-matched them with 426 controls who had not experienced stroke.
All of the participants completed a modified version of the Perceived Stress Scale (PSS), a standardized questionnaire measuring stress levels over a 1-month period. Patients who experienced stroke were asked to report their stress levels in the month preceding their stroke. The questionnaire included ten items such as "In the last month, how often have you felt that you were unable to control the important things in your life?" with responses scored from 0 ("never") to 4 ("very often").
Total scores were categorized as follows:
- Low stress: 0 to 13 points
- Moderate stress: 14 to 26 points
- High stress: 27 to 40 points.
The investigators found that patients who experienced cryptogenic ischemic stroke exhibited higher average stress scores (13) compared with the control group (10). Additionally, 46.2% of those who experienced cryptogenic ischemic stroke reported moderate to high stress levels vs 33.3% of controls.
After controlling for potential confounding factors including education level, alcohol consumption, blood pressure, and other traditional risk factors, the investigators identified a significant association between stress and cryptogenic ischemic stroke risk, specifically in female participants. Women with moderate stress levels showed a 78% increased risk of cryptogenic ischemic stroke, whereas those with high stress levels demonstrated a 6% increased risk.
Notably, this association was not observed in male participants, suggesting potential sex-based differences in how stress might contribute to cryptogenic ischemic stroke risk.
When stratified by age, higher stress as a discrete measure was significantly associated with cryptogenic ischemic stroke only in patients aged 18 to 39 years.
"More research is needed to understand why women who feel stressed, but not men, may have a higher risk of stroke," said Dr. Martinez-Majander. "In addition, we need to further explore why the risk of stroke in women was higher for moderate stress than high stress. Knowing more about how stress plays a role could help us to create better ways to prevent these strokes," he underscored.
The research has several strengths, including its multicenter design across 19 European centers and comprehensive diagnostic evaluations for all participants. However, the investigators acknowledged potential limitations, including the retrospective evaluation of prestroke stress conducted after the stroke event, which may have introduced recall bias.
They also noted that individuals experiencing higher stress levels might have been less likely to participate in the study, potentially affecting the results.
Full disclosures are available in the study.