Psychosocial stress possibly tied to stroke subtype
Key takeaways:
- Intracerebral hemorrhage risk was tied to various forms of stress, including family and financial stress.
- Stress had a disproportionate impact on stroke risk among Black and Hispanic patients vs. white patients.
Psychosocial stress, especially financial stress, was associated with increased odds of experiencing intracerebral hemorrhage, with a particularly strong effect among Black and Hispanic patients, researchers reported.
Hypertension mediated some of the relationship between stress and intracerebral hemorrhage (ICH), but not all, according to data published in the Journal of the American Heart Association.
“ICH accounts for 10% to 15% of all strokes and is the most severe subtype, associated with high rates of morbidity and mortality,” Tyler P. Behymer, BS, senior clinical research professional at the University of Cincinnati College of Medicine, and colleagues wrote. “The numerous mechanisms by which stress exerts its effects on the vascular and cerebrovascular systems are incompletely understood. ... Here, we use a large, multicenter, multi-race/ethnic, case-control study of ICH to test the hypothesis that psychosocial stress is a significant risk factor for ICH, rather than mediated by race or ethnicity or hypertension alone.”
The researchers used data from the ERICH study to assess the impact of four types of stress — financial, health, emotional well-being and family — on risk for ICH.
ERICH was a prospective, multicenter, case-control study of spontaneous ICH in which 3,000 white, Black and Hispanic patients were matched 1:1 to controls based on sex and race/ethnicity (41% women; 34% Black; 33% Hispanic). Participants were asked to recall and rate their perceived stress during the week before their ICH on scale of 0 to 10.
Elevated levels of all forms of stress — financial, health, emotional well-being, family and total stress — were associated with increased likelihood of ICH, with odds ratios ranging from 1.03 for high total stress (95% CI, 1.02-1.04; P < .0001) to 1.12 for emotional well-being stress (95% CI, 1.09-1.14; P < .0001).
The presence of hypertension significantly mediated probability of ICH associated with health, emotional well-being, family and total stress, but not financial stress, according to the study.
Moreover, financial stress was particularly associated with nonlobar ICH (OR = 1.05; 95% CI, 1.02-1.08; P = .0005) and had a disproportionately larger impact on risk among Black (OR = 3.9; 95% CI, 2.4-6.2; P < .0001) and Hispanic patients (OR = 3; 95% CI, 1.8-4.9; P < .0001) compared with white patients.
“Our findings offer a new target for ICH risk modification, and risk factor management should include attention to this modifiable risk factor,” the researchers wrote. “Stress as a highly prevalent risk factor with important racial/ethnic differences warrants future studies to delineate the complex mechanisms for this association, which may lead to changes in stroke prevention and management in the future.”
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