Psychological and work stress were linked to a higher risk of first stroke

Design

Systematic review and meta-analysis of cohort and case-control studies

Population

84 studies, 4,128,167 participants without prior stroke

Primary outcome

First-ever stroke

Effect

Psychological stress HR 1.27 (1.19-1.36); work stress HR 1.32 (1.23-1.43)

This meta-analysis pooled 84 observational studies (72 cohort, 12 case-control) with more than four million participants who had not had a stroke.

In cohort studies, psychological stress was associated with a higher risk of first stroke (HR 1.27, 95% CI 1.19 to 1.36), as was work stress (HR 1.32, 1.23 to 1.43). Interpersonal stress showed a smaller association (HR 1.11). The association in men was significant and in women was not, but the difference between sexes was not statistically established.

These are associations, and stressed people may also smoke more, sleep less and take treatment less reliably. The practical point is that stress belongs in a cardiovascular risk conversation alongside the conventional factors.

• Ask about work and personal stress when reviewing cardiovascular risk.
• Check that stressed patients' blood pressure, smoking and adherence are not slipping.
• Offer practical support such as sleep advice, physical activity and referral for counselling where available.
• Do not present stress reduction as a substitute for treating blood pressure or lipids.

Why it matters

Stress is rarely recorded in a risk review, yet it was associated with as much excess risk as some factors that are.

Don't overread it

The studies were observational; they cannot show that reducing stress prevents stroke.

The statistics, in plain English

A hazard ratio of 1.27 means first strokes occurred about a quarter more often in people reporting psychological stress. Because this is observational, other habits linked to stress may explain part of it.

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