Stress and negative emotions adversely affect cardiovascular disease morbidity and mortality, but little is known about their impact on stroke risk. Most existing evidence is from homogenous white populations [1,2]. The international Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World (INTERSTROKE) demonstrated that single-item measures of psychosocial stress and depression were significant stroke risk factors [3].
Much of the available evidence is limited by the absence of adjudicated stroke events, and/or limited risk factor data or limited assessment of psychosocial factors. This study therefore used data from the Multi-Ethnic Study of Atherosclerosis (MESA) to investigate the association of chronic stress and negative emotions with a combined endpoint of incident stroke and transient ischaemic attacks (TIAs). Mean follow-up in this longitudinal observational study was 8.5 years (range: 0.02-10.9 years).
This study shows that more depressive symptoms, greater chronic stress and higher levels of hostility were associated with an increased risk of stroke and TIA, which could not be explained by traditional stroke risk factors, inflammatory markers or subclinical atherosclerosis. The association between anger and stroke/TIA did not reach statistical significance.
These results underscore the importance of considering non-traditional factors when assessing stroke/TIA risk. MESA is a population-based study, including participants from 4 racial/ethnic groups, which enhances the generalisability of the findings.
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