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Reddin C, Murphy R, Hankey GJ, Judge C, Xavier D, Rosengren A, Ferguson J, Alvarez-Iglesias A, Oveisgharan S, Iversen HK, Lanas F, Al-Hussein F, Członkowska A, Oguz A, McDermott C, Pogosova N, Málaga G, Langhorne P, Wang X, Wasay M, Yusuf S, O’Donnell M. Association of Psychosocial Stress With Risk of Acute Stroke. JAMA Netw Open 2022; 5:e2244836. [PMID: 36484991 PMCID: PMC9856236 DOI: 10.1001/jamanetworkopen.2022.44836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions. OBJECTIVES To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population. DESIGN, SETTING, AND PARTICIPANTS INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13 462 patients with stroke and 13 488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13 350 cases and 13 462 controls with available data on psychosocial stress. EXPOSURES Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work. MAIN OUTCOMES AND MEASURES The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control. RESULTS Among 26 812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58]; P = .008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < .001 for interaction) for acute stroke. CONCLUSIONS AND RELEVANCE Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.
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Affiliation(s)
- Catriona Reddin
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Wellcome Trust–HRB, Irish Clinical Academic Training, Dublin, Ireland
| | - Robert Murphy
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Conor Judge
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Wellcome Trust–HRB, Irish Clinical Academic Training, Dublin, Ireland
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Denis Xavier
- Division of Clinical Research and Training, St Johns Medical College and Research Institute, Bangalore, India
| | - Annika Rosengren
- Cardiology Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Ferguson
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Alberto Alvarez-Iglesias
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, Illinois
| | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Fawaz Al-Hussein
- Department of Neurology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Dumlupinar Mahallesi, Istanbul, Turkey
| | - Clodagh McDermott
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - German Málaga
- Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | - Xingyu Wang
- Beijing Hypertension League Institute, Beijing, China
| | - Mohammad Wasay
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin O’Donnell
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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