Thread by @hyderabaddoctor

Psychosocial #Stress increases the risk of #stroke

1. A longitudinal study (2007-2021) was conducted on 27,000 people from 32 countries belonging to various continents to assess the relation of self-reported stress and risk of various types of stroke
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2. Increased stress at home and at work (within the previous 12 months) increased the risk of stroke by 95% (1.95 times) and 170% (2.7 times) respectively, as compared to no self-reported stress. Recent stressful events increased the risk of stroke by 1.3 times.

3. This association was consistent for all stress domains, including work stress, home stress, and financial stress. The association was independent of socioeconomic status, occupation, and educational level & remained significant after adjustment for cardiovascular risk factors.

4. Stress is a stronger risk factor for #brain hemorrhage than for ischemic stroke.
The European Society of #Cardiology and American Heart Association guidelines for cardiovascular prevention include stress as a modifiable risk factor for stroke and coronary heart disease.

5. Stress management and counselling on psychosocial risk factors are recommended for individuals at a very high risk of cardiovascular disease.

6. Interventions to reduce stress included in studies are multi-component, and the most common domains are cognitive behavioral therapy, relaxation techniques, client-led discussion, stress management, exercise regimens, and anger management.

7. Several mechanisms can explain the association between stress and stroke or cardiovascular risk.
Acute stress may trigger an event by leading to activation of the sympathetic nervous system causing vasoconstriction and plaque rupture in vulnerable individuals.

8. Chronic stress may cause dysregulation of the sympathetic system, endothelial dysfunction, and atherosclerosis.
Stress may indirectly increase stroke risk by fostering unhealthy behaviors.

9. Those who report several periods of general stress or permanent general stress are more likely to be mainly sedentary, have higher body mass index, and more frequently report high levels of alcohol intake.
Feeling of being in control at home and at work place can reduce stress

10. Take home message:
*Stress is an important modifiable risk factor for ischemic as well as hemorrhagic strokes.

*Reducing stress can significantly reduce the incidence of stroke.

Reference
jamanetwork.com/journals/jaman…