and Medicine for Seniors
Stroke Risk in Seniors, Middle-Age
Adults Jumps with Stress, Hostility, Depression
Psychological characteristics equally
important to cholesterol, blood pressure, smoking other traditional risk
11, 2014 - Higher levels of stress, hostility and depressive symptoms
are associated with significantly increased risk of
or transient ischemic attack (TIA)
in middle-age adults and seniors, according to new research in the
American Heart Association journal Stroke. Interestingly,
anger was not seen to cause a significant increase in stroke risk.
A TIA is a stroke caused by a
temporary blockage of blood flow to the brain.
Researchers investigated how
psychological factors might influence risk for chronic disease, using
data from the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing
study on cardiovascular disease risk factors in participants living in
six U.S. cities.
More than 6,700 adults (ages 45-84;
53 percent women) completed questionnaires assessing chronic stress,
depressive symptoms, anger and hostility over two years. Participants
were 38.5 percent white, 27.8 percent African-American, 11.8 percent
Chinese and 21.9 percent Hispanic. All were free of cardiovascular
disease at the start of the study.
In follow-up for an additional 8.5
to 11 years, 147 strokes and 48 TIAs occurred.
Compared to people with the lowest
psychological scores, those with highest scores were:
• 86 percent more likely to have
a stroke or TIA for high depressive symptoms.
• 59 percent more likely to have
a stroke or TIA for the highest chronic stress scores.
• More than twice as likely to
have a stroke or TIA for the highest hostility scores.
“There’s such a focus on
traditional risk factors — cholesterol levels, blood pressure, smoking
and so forth — and those are all very important, but studies like this
one show that psychological characteristics are equally important,” said
Susan Everson-Rose, Ph.D., M.P.H., study lead author and associate
professor of medicine at the University of Minnesota in Minneapolis.
These associations noted in the
study were significant even when researchers accounted for age, race,
sex, health behaviors and other known risk factors of stroke.
“Given our aging population, it’s
important to consider these other factors that might play a role in
disease risk. Stroke is a disease of the elderly predominantly, and so
learning more about things that can influence risk for stroke as people
age is important.”
Researchers measured chronic stress
in five domains: personal health problems, health problems of others
close to the participant, job or ability to work, relationships and
They assessed depressive symptoms
with a 20-question scale and analyzed anger with a 10-item scale that
captured the extent and frequency of experiencing that emotion.
Hostility, which is a negative way of viewing the world, was measured by
assessing a person’s cynical expectations of other people’s motives.
“One thing we didn’t assess is
coping strategies,” Everson-Rose said. “If someone is experiencing
depressive symptoms or feeling a lot of stress or hostility, we don’t
know how they manage those, so it’s possible that positive coping
strategies could ameliorate some of these associations or effects,” she
“We did not inquire about coping. I
would say that’s one of the tasks for future studies.”
Researchers didn’t identify
potential racial and ethnic differences or sex differences in the
observed associations, but were not able to fully examine such
differences due to the smaller numbers of strokes in some groups.
Co-authors are Nicholas Roetker,
B.A.; Pamela Lutsey, Ph.D., M.P.H.; Kiarri Kershaw, Ph.D., M.P.H.; W.T.
Longstreth Jr., M.D., M.P.H.; Ralph Sacco, M.D., M.S.; Ana Diez Roux,
M.D., Ph.D., M.P.H.; Alvaro Alonso, M.D., Ph.D. Author disclosures are
on the manuscript.
The National Heart, Lung, and Blood
Institute funded the study.
Animation of Ischemic Stroke by American Heart Association
What is a Stroke?
Stress and Heart Health
How does depression affect the heart?
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