Anxiety linked to higher long-term risk of stroke
The greater your anxiety level, the higher your risk of having a stroke, according to new research published in the American Heart Association journal Stroke.
The study is the first in which researchers linked anxiety and stroke independent of other factors such as depression. Anxiety disorders are one of the most prevalent mental health problems. Symptoms include feeling unusually worried, stressed, nervous or tense.
Over a 22 year period, researchers studied a nationally representative group of 6,019 people 25-74 years old in the first National Health and Nutrition Examination Survey (NHANES I).
Participants underwent an interview and took blood tests, medical examinations and completed psychological questionnaires to gauge anxiety and depression levels.
Researchers tracked strokes through hospital or nursing home reports and death certificates. After accounting for other factors, they found that even modest increases in anxiety were associated with greater stroke risk.
People in the highest third of anxiety symptoms had a 33 percent higher stroke risk than those with the lowest levels.
Even a minor stroke might lead to stress and anxiety
A stroke, or brain attack, is caused by bleeding inside the head or sudden loss of blood flow to the brain. A stroke can cause brain cells to die, so a person with a stroke might have paralysis, loss of feeling, speech problems, or memory and reasoning problems. The damage left by a stroke might also cause emotional problems such as depression. In this issue of Neurology, researchers in Switzerland1 looked for evidence that people who have had a stroke might have anxiety. Specifically, these researchers wanted to know whether living through the experience of a stroke might have caused an anxiety problem called posttraumatic stress disorder, or PTSD. This is a condition that can happen after a life-threatening or traumatic event, when the person feels as though he or she is re-experiencing the event. Usually the person does not want to think about what happened because it makes him or her feel numb or nervous and uncomfortable. More information about PTSD can be found on the next page.
How could a stroke cause PTSD?
The researchers had the idea that even a minor stroke could be a frightening enough event to result in PTSD. The researchers thought that if people did not know what was happening to them when they had a stroke, and if they reacted strongly with fear or worry, they might have some nervous anxiety about the stroke. Also, the researchers thought that if patients did not remember exactly what happened, or if they were not aware of the cause of their stroke, they might have more fear and worry about it. These ideas were put to the test in this research.
Karin J.M. McCoy, PhD
doi: 10.1212/01.wnl.0000203810.16277.32 Neurology February 28, 2006 vol. 66 no. 4 E15-E16
“Everyone has some anxiety now and then. But when it’s elevated and/or chronic, it may have an effect on your vasculature years down the road,” said Maya Lambiase, Ph.D., study author and cardiovascular behavioral medicine researcher in the Department of Psychiatry at the University of Pittsburgh School of Medicine, in Pittsburgh, Penn.
People with high anxiety levels are more likely to smoke and be physically inactive, possibly explaining part of the anxiety-stroke link. Higher stress hormone levels, heart rate or blood pressure could also be factors, Lambiase said.
The researchers pointed out that anxiety can be related to smoking and increased pulse and blood pressure, which are known risk factors for stroke. However, Lubin still has her doubts.
“It still seems a little hard to fully buy into the fact that anxiety itself is a major risk factor that we need to deal with,” she said.
Lubin said that treating risk factors like smoking, high blood pressure and diabetes are the keys to preventing stroke. “I doubt that treating anxiety itself is going to decrease the risk of stroke,” she said.
The report was published Dec. 19 in the online edition of the journal Stroke.
The study was led by Maya Lambiase, a cardiovascular behavioral medicine researcher in the department of psychiatry at the University of Pittsburgh School of Medicine. Her team collected data on more than 6,000 people aged 25 to 74 when they enrolled in the first U.S. National Health and Nutrition Examination Survey, started in the early 1970s.
These people were interviewed and had medical tests and completed questionnaires to assess their levels of anxiety and depression.
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By Steven Reinberg
In earlier work, researchers found that depression was linked to greater risk of stroke. In contrast to anxiety, depression is a persistent feeling of hopelessness, dejection, and lack of energy, among other symptoms. Stroke is the No. 4 killer and a leading cause of disability in the United States.
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Co-authors are Laura Kubzansky, Ph.D. and Rebecca Thurston, Ph.D. Author disclosures are on the manuscript.
The National Heart, Lung, and Blood Institute and the National Institute of Mental Health funded the study.
Anxiety is one of the most common mental health problems people face, and a lot more people have anxiety than depression, Krakower said. “And it’s often overlooked,” he noted.
Treating anxiety might not lower the risk for stroke, “but it will improve your quality of life,” he added.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.
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Darcy Spitz
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American Heart Association