Psychological and work stress were each associated with about 30% higher risk of first stroke

Design

Systematic review and meta-analysis of 84 observational studies

Population

4,128,167 stroke-free adults

Primary outcome

First-ever stroke

Effect

Psychological stress HR 1.27 (95% CI 1.19–1.36); work stress HR 1.32 (1.23–1.43)

This systematic review and meta-analysis pooled 84 studies (72 prospective cohorts, 12 case-control) including 4.1 million people without prior stroke. Stressors were grouped as psychological, vocational, interpersonal and behavioural.

In cohort studies, psychological stress was associated with higher risk of first stroke (HR 1.27, 95% CI 1.19–1.36), as was work-related stress (HR 1.32, 1.23–1.43). Interpersonal stress showed a smaller association (HR 1.11). Behavioural stress traits showed the largest estimate (HR 1.51) but from only three cohorts. The association was significant in men and not in women, but the interaction was not significant, so no sex difference is established.

These are associations from observational data and could partly reflect confounding by smoking, blood pressure, sleep and socioeconomic status. But the size is similar to that of some established risk factors, and the INTERSTROKE study already listed psychosocial stress among the modifiable contributors. It argues for asking about stress when assessing stroke risk — and treating the blood pressure, smoking and sleep problems that often travel with it.

• Ask about psychological and work stress when assessing stroke risk, alongside blood pressure, lipids and smoking.
• Check blood pressure carefully in patients reporting chronic stress; it is a likely pathway.
• Screen for depression and poor sleep, which cluster with stress and stroke risk.
• Offer practical stress-reduction support; its effect on stroke itself is unproven.

Why it matters

Stress is usually left out of stroke-risk assessment, yet its association is comparable to some factors clinicians routinely record.

Don't overread it

This is pooled observational evidence — it shows an association, not that reducing stress prevents stroke.

The statistics, in plain English

An HR of 1.27 means about 27% higher relative risk; for someone whose 10-year stroke risk is 5%, that is roughly 6.4%. Pooling many observational studies narrows the confidence interval but does not remove shared confounding.

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