Is psycho-physical stress a risk factor for stroke? A case-control study
- Jose Antonio Egido1,
- Olga Castillo1,
- Beatriz Roig1,
- Isabel Sanz1,
- Maria Rosa Herrero1,
- Maria Teresa Garay1,
- Ana María Garcia1,
- Manuel Fuentes2,
- Cristina Fernandez2
- 1Stroke Unit, Department of Neurology, Hospital Clinico Universitario San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- 2Unidad de Gestión Clínica Servicio de Medicina Preventiva, Unidad de Metodología de Investigación y Epidemiología Clínica, Hospital Clínico San Carlos, Escuela de Enfermería, Universidad Complutense de Madrid, Universidad Camilo Jose Cela. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Correspondence to Dr Jose Antonio Egido, Stroke Unit coordinator, Department of Neurology, Hospital Clinico Universitario San Carlos, Avda/ Martin Lagos, s/n. 28040 Madrid, Spain;
Contributors JAE, OC, BR, IS, MRH, MTG, MF and CF: Design of the study and patient care. OC, BR, IS, MRH, MTG: data collection. OC, BR, IS, MRH, MTG, MF and CF: questionnaire design. MF and CF: statistical analysis. JAE, MF and CF: manuscript preparation. OC, BR, IS, MRH, MTG, AMG: input in drafting the manuscript. JAE is the overall guarantor of validity of the study.
- Received 2 February 2012
- Revised 16 June 2012
- Accepted 25 June 2012
- Published Online First 27 August 2012
Background Chronic stress is associated with cardiovascular diseases, but the link with stroke has not been well established. Stress is influenced by life-style habits, personality type and anxiety levels. We sought to evaluate psycho-physical stress as a risk factor for stroke, while assessing gender influences.
Methods Case-control study. Cases: patients (n=150) aged 18–65, admitted consecutively to our Stroke Unit with the diagnosis of incident stroke. Controls: (n=300) neighbours (paired with case ±5 years) recruited from the census registry. Study variables: socio-demographic characteristics, vascular risk factors, psychophysical scales of H&R (Holmes & Rahe questionnaire of life events), ERCTA (Recall Scale of Type A Behaviour), SF12 (QoL scale), GHQ28 (General Health Questionnaire). Statistical analyses included conditional multiple logistic regression models.
Results Mean age was 53.8 years (SD: 9.3). Compared with controls, and following adjustment for confounding variables, significant associations between stroke and stress were: H&R values >150 OR=3.84 (95% CI 1.91 to 7.70, p<0.001); ERCTA (values >24) OR=2.23 (95% CI 1.19 to 4.18, p=0.012); mental SF12 (values >50) OR=0.73 (95% CI 0.39 to 1.37, p=0.330); psychological SF12 (values >50) OR=0.66 (95% CI 0.33 to 1.30, p=0.229), male gender OR=9.33 (95% CI 4.53 to 19.22, p<0.001), high consumption of energy-providing beverages OR=2.63 (95% CI 1.30 to 5.31, p=0.007), current smoker OR=2.08 (95% CI 1.01 to 4.27, p=0.046), ex-smoker OR=2.35 (95% CI 1.07 to 5.12, p=0.032), cardiac arrhythmia OR=3.18 (95% CI 1.19 to 8.51, p=0.022) and Epworth scale (≥9) OR=2.83 (95% CI 1.03 to 7.78, p=0.044).
Conclusions Compared with healthy age-matched individuals, stressful habits and type A behaviour are associated with high risk of stroke. This association is not modified by gender.
- cerebrovascular disease
- quality of life
- subarachnoid haemorrhage, ultrasound
Funding This study was funded, in part, by a grant from the Health Research Foundation [Fondo Investigacion Sanitaria; FIS PI7/0124] within the European Regional Development Fund [Fondo Europeo de Desarrollo Regional; FEDER].
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by ethics committee Hospital Clínico San Carlos.
Provenance and peer review Not commissioned; externally peer reviewed.