Managing Stress Could Lower Stroke Risk in Younger Adults

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Young adults (aged 18 to 39 years) with moderate stress levels had a significantly increased risk of cryptogenic ischemic stroke (CIS), even after adjusting for traditional stroke risk factors. Findings of the new study suggest stress management may play a role in reducing the risk of early-onset strokes, particularly in women, although recall bias should be considered.

“Stress could be one of the factors explaining ischemic stroke in modern times, especially among younger individuals, due to the increasing demands and pressures associated with work, including long hours, job insecurity and high expectations,” wrote a team of international investigators including Nicolas Martinez-Majander, M.D., Ph.D., adjunct professor at the Clinical Stroke Research Center at Helsinki University Hospital in Finland. “In addition, family matters and financial burdens can also contribute significantly to chronic stress. Consequently, the relationship between self-perceived stress and IS at young age has gained increasing scientific interest.”

Previous research further implies this connection, as one Swedish study reported psychological stress was linked to a 3.5-fold increased risk of stroke and an analysis of West Africans with ischemic stroke showed a 3-fold increased risk of stress in the two-week period before the incident.

Therefore, investigators explored the link between self-perceived stress and CIS in young adults aged 18 to 49, stratified by sex and age, between November 2013 and November 2022. Patients from 19 European centers with a first-ever CIS were matched with stroke-free controls. They were recruited from the prospective multicenter Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO) study.

A modified Perceived Stress Scale (PSS), a widely recognized 10-question evaluation, was used to determine self-perceived stress. Scores were organized into low (0-13), moderate (14-26) and high (27-40) perceived stress. Analyses were adjusted for age, education level, migraine with aura, and other traditional risk factors, such as diabetes, hypertension, smoking, diet, obesity, cardiovascular diseases, depression, heavy alcohol consumption and physical inactivity.

In total, 426 patients (47.7% women) with CIS and 426 controls were included in the study with a median age of 41 years. Those in the CIS cohort were more often at least moderately stressed when compared with the control group (46.2% vs 33.3%, respectively). The stroke severity did not differ between patients with low, moderate or high levels of stress. Participants in the CIS group had a higher prevalence of traditional risk factors, low level of education and migraine with aura.

The PSS revealed that moderate stress was independently associated with a higher risk of CIS, but not high stress. This risk was particularly significant in women, but not men, and younger adults (18-39 years).

Investigators noted adjusting for confounders and using patients from 19 centers across Europe strengthened the findings and led to increased generalizability. However, there may be a potential for selection bias toward patients with milder strokes. Additionally, recall bias may have hindered results as the patients’ prestroke stress was assessed poststroke. The team was also unable to collect data on early life stress or adverse childhood experiences of participants, which have been shown to influence self-perceived stress levels in adulthood.

“Further research is needed to delve deeper into the mechanisms that heighten the risk of early-onset CIS in individuals experiencing self-perceived stress, particularly focusing on the impact on the coagulation system and related pathways,” investigators concluded. “Given the potential importance of CIS in the context of early-onset strokes, understanding the role of self-perceived stress in this population may be crucial for developing more effective prevention strategies.”