Having a lot of stress, hostility and depression was associated with a significantly higher risk of stroke or transient ischemic attack in middle-aged and older adults, according to new research.

A TIA is a stroke caused by a temporary blockage of blood flow to the brain.

Researchers studied how psychological factors influenced risk for chronic disease, using data from an ongoing study on cardiovascular disease risk factors in people living in six U.S. cities.

More than 6,700 adults, aged 45-84, with 53 percent women completed questionnaires about chronic stress, depression, anger and hostility over two years. Participants were 38.5 percent white, 27.8 percent African-American, 21.9 percent Hispanic and 11.8 percent Chinese. None of them had cardiovascular disease when the study began.

During another 8.5 to 11 years of follow up, there were 147 strokes and 48 TIAs.

Compared to people with the lowest psychological scores, those with highest scores were:

  • 86 percent more likely to have a stroke or TIA if they had depression.
  • 59 percent more likely to have a stroke or TIA if they had chronic stress.
  • More than twice as likely to have a stroke or TIA if they had hostility.
  • Not significantly higher risk if they had anger.

“There’s such a focus on traditional risk factors — cholesterol levels, blood pressure, smoking and so forth — and those are all very important, but studies like this one show that psychological characteristics are equally important,” said Susan Everson-Rose, Ph.D., M.P.H., lead author of the study and associate professor of medicine at the University of Minnesota in Minneapolis.

The associations were significant even after researchers accounted for age, race, sex, health behaviors and other known risk factors of stroke.

“Given our aging population, it’s important to consider these other factors that might play a role in disease risk. Stroke is a disease of the elderly predominantly, and so learning more about things that can influence risk for stroke as people age is important.”

Chronic stress of participants was measured by five factors: personal health problems, health problems of people close to them, job or ability to work, relationships and finances.

Researchers used a 20-question scale to measure depression and a 10-item scale for anger. They tracked hostility, a negative view of the world, by assessing a person’s cynical expectations of the motives of others.

“One thing we didn’t assess is coping strategies,” Everson-Rose said. “If someone is experiencing depressive symptoms or feeling a lot of stress or hostility, we don’t know how they manage those, so it’s possible that positive coping strategies could ameliorate some of these associations or effects,” she said.

The study appeared in the American Heart Association journal Stroke.

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