Enhancing stress coping strategies may lower stroke risk, study recommends

Ireland: An original investigation on Neurology published in the JAMA Network has concluded that self-reported psychosocial stress is tied to increased risk of all stroke, ischemic and hemorrhagic, within the previous 12 months and was found to be consistent for all stress domains, including work, home and financial stress.

The study highlighted that association is independent of socioeconomic status, occupation, and educational level, and it remained significant even after adjustment for cardiovascular risk factors. Some associations may be independent of other cardiovascular risk factors like blood pressure, smoking and unhealthy diet.

It is already known that psychosocial stress is a risk factor for acute stroke. To be more precise, it is a modifiable risk factor for stroke.

 Given the acute and chronic stress prevalence, it is a potentially attractive target for population-health interventions.

The question here is,

Is there an association between psychosocial stress and increased acute stroke risk, and does this risk modified by a higher locus of control?

Locus of control is defined as enhancing coping strategies or environmental factors to mitigate the impact of stress.

To investigate this, a case-control study was conducted by lead researcher Dr Reddin from the Health Research Board Clinical Research Facility Galway from School of Medicine at the University of Galway.

The key points of the study are:

• INTERSTROKE is an international study of risk factors for the first acute stroke in 32 countries.

• A total of 13,462 patients with a history of stroke and 13,488 participants of matched controls were recruited ( January 11, 2007, - August 8, 2015).

• There was the availability of data for 13,350 cases and 13,462 controls. Analysis was done from June 1 to 30, 2021.

• The Exposure in the study was Psychosocial stress and stressful life events within the preceding year.

• The psychosocial stress was measured using a standardized stress questionnaire at home and work (self-reported).

• The association of stress with acute stroke was the primary outcome measured.

• Multivariable conditional logistic regression was used in the study.

• The present analysis included 26,812 participants.

• The mean age of cases and control was 62.2 years and 61.3 years.

• There were 7960 cases and 8017 controls.

• In 2745 cases and 1933 controls constituting 20.5 % and 14.4%, periods of stress and permanent stress were reported.

• The findings showed variation in prevalence, with the lowest in China (5.0% for controls and 9.1% for cases) and the highest in South East Asia (26.1% among controls and 30.8% among patients).

• Increased stress at home had an odds ratio of 1.95, and OR at work was 2.70. The recent stressful life events had an OR of 1.31.

• These were associated with increased acute stroke risk.

• There was an association between a higher locus of control at home and reduced odds of all strokes.

• There was an association between higher locus of control at work and home and lower odds of acute stroke, thereby significantly diminishing the association with stress at work and at home with an OR of 2.20 and 1.69, respectively for acute stroke.

They said the study's findings recommend that a higher locus of control is tied to a lower risk of stroke, a significant effect modifier of the risk associated with psychosocial stress.

Self-reported psychosocial stress increases the risk of all strokes. Higher locus of control at work and home is associated with the diminished magnitude of context-specific psychosocial stress and acute stroke odds.

Findings:

Reddin C, Murphy R, Hankey GJ, et al. Association of Psychosocial Stress With Risk of Acute Stroke. JAMA Netw Open. 2022;5(12):e2244836. doi:10.1001/jamanetworkopen.2022.44836