J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-302420
  • Cerebrovascular disease
  • Research paper

Is psycho-physical stress a risk factor for stroke? A case-control study

Press Release
  1. Cristina Fernandez2
  1. 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
  2. 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
  1. 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; jegidoh{at}
  1. 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.


  • 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.

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