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Psychosocial distress may compound stroke risk in older adults
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Increased psychosocial distress was associated with an increased risk for both fatal and nonfatal stroke in older adults, according to recent study results.
“This study identified a robust relationship between psychosocial distress and increased risk of stroke mortality and incident stroke in over 6 years of follow-up in a population-based cohort of older black and white adults,” the researchers wrote. “Moreover, a clear dose-response pattern of associations was evident, with the most distressed participants experiencing more than a twofold increased risk of incident stroke.”
Susan A. Everson-Rose, PhD, MPH, and colleagues of the University of Minnesota examined data on black and white adults aged at least 65 years who were enrolled in the Chicago Health and Aging Project, a longitudinal population-based study on Alzheimer’s disease and other illnesses among seniors. Baseline interviews were conducted in participants’ homes, covering medical history, cognitive health, socioeconomic status, behavioral patterns and psychosocial characteristics. The researchers obtained follow-up data on fatal strokes in 4,120 seniors and nonfatal strokes in 2,649 seniors.
Psychosocial distress was measured according to depressive symptoms, perceived stress, neuroticism and life satisfaction.
Adjusting for age, race and sex, the researchers found that each increase of one standard deviation in psychosocial distress score was associated with a 47% greater risk of dying from stroke (HR=1.47; 95% CI, 1.28-1.7) and an 18% greater risk for incident stroke (HR=1.18; 95% CI, 1.07-1.3). The association between psychosocial distress and stroke mortality remained significant even after controlling for stroke risk factors (HR=1.29; 95% CI, 1.1-1.52), but the association did not remain significant for incident stroke (HR=1.09; 95% CI, 0.98-1.21).
Further analysis of stroke subtypes indicated that distress was strongly associated with incident hemorrhagic strokes (HR=1.7; 95% CI, 1.28-2.25), but not ischemic strokes (HR=1.02; 95% CI, 0.91-1.15).
“This study provides important evidence linking psychosocial distress to risk of both fatal and nonfatal stroke outcomes in elderly blacks and whites,” the researchers concluded. “The biological mechanisms underlying these associations remain to be determined, although our data suggest that pathways related to nonischemic disease mechanisms may be critical.”
Disclosure: The researchers report no relevant financial disclosures.
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Larry B. Goldstein, MD, FAAN, FAHA
This interesting study reports an association between measures of psychosocial stress and hemorrhagic, but not ischemic, stroke and with stroke-related mortality. It is important to note that associations with incident stroke were significant in partially adjusted, but not fully adjusted, models. Those with higher levels of psychosocial stress differed in several ways from those with lower levels of stress. Although measured risk factors were accounted for in the adjusted models, studies of this type are always subject to residual confounding that could further attenuate the observed relationships. In addition, some factors such as diet and alcohol consumption were not assessed, and changes over time were not measured. The observations will also need to be replicated in other datasets.
The study does, however, reinforce that patients should be assessed for psychosocial stress as part of their regular medical evaluations. Addressing these issues may often go beyond what is available through medical interactions.
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