In the JournalsPerspective

Type A personality and stress linked to high risk for stroke

Type A personality traits and chronic stress were associated with high risk for stroke, according to recent study results published in the Journal of Neurology, Neurosurgery & Psychiatry.

“Several studies highlight stress as an independent risk factor in cardiovascular diseases, but there is a dearth of in-depth studies evaluating the psycho-physical bases of stress and stroke,” the researchers wrote.

Jose Antonio Egido, MD, of the stroke unit at the Hospital Clinico Universitario San Carlos in Madrid, and colleagues compared 150 patients aged 18 to 65 years who were admitted to the stroke unit with a diagnosis of stroke with 300 healthy adults who were matched for age and resided in the same neighborhood as the stroke patients.

The researchers measured psychophysical stress based on four assessments: stressful experiences over the previous year; psychosocial problems, including distress, anxiety, social dysfunction and depression; quality of life; and type A behavior patterns.

Type A behaviors included competitiveness, hostility, aggression, impatience and quick temper. Participants were assessed for diabetes, hypertension, hypercholesterolaemia, history of alterations in cardiac rhythm and atrial fibrillation. Egido and colleagues also looked at lifestyle factors, including smoking and the use of recreational drugs, caffeine, alcohol and energy drinks.

Results showed that risk for stroke was almost four times higher among participants who had experienced a stressful life event in the past year (OR=3.84; 95% CI, 1.91-7.70). Those who exhibited greater type A personality behaviors were at more than twice the risk for stroke (OR=2.23; 95% CI, 1.19-4.18).

Other factors independently associated with a greater risk for stroke included smoking (OR=2.08; 95% CI, 1.01-4.27), male gender (OR=9.33; 95% CI, 4.53-19.22), cardiac arrhythmia (OR=3.18; 95% CI, 1.19-8.15) and high consumption of energy drinks (OR=2.63; 95% CI, 1.30-5.31).

“Addressing the influence of psychophysical factors on stroke could constitute an additional therapeutic line in the primary prevention of stroke in the at-risk population and, as such, warrants further investigation,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

Type A personality traits and chronic stress were associated with high risk for stroke, according to recent study results published in the Journal of Neurology, Neurosurgery & Psychiatry.

“Several studies highlight stress as an independent risk factor in cardiovascular diseases, but there is a dearth of in-depth studies evaluating the psycho-physical bases of stress and stroke,” the researchers wrote.

Jose Antonio Egido, MD, of the stroke unit at the Hospital Clinico Universitario San Carlos in Madrid, and colleagues compared 150 patients aged 18 to 65 years who were admitted to the stroke unit with a diagnosis of stroke with 300 healthy adults who were matched for age and resided in the same neighborhood as the stroke patients.

The researchers measured psychophysical stress based on four assessments: stressful experiences over the previous year; psychosocial problems, including distress, anxiety, social dysfunction and depression; quality of life; and type A behavior patterns.

Type A behaviors included competitiveness, hostility, aggression, impatience and quick temper. Participants were assessed for diabetes, hypertension, hypercholesterolaemia, history of alterations in cardiac rhythm and atrial fibrillation. Egido and colleagues also looked at lifestyle factors, including smoking and the use of recreational drugs, caffeine, alcohol and energy drinks.

Results showed that risk for stroke was almost four times higher among participants who had experienced a stressful life event in the past year (OR=3.84; 95% CI, 1.91-7.70). Those who exhibited greater type A personality behaviors were at more than twice the risk for stroke (OR=2.23; 95% CI, 1.19-4.18).

Other factors independently associated with a greater risk for stroke included smoking (OR=2.08; 95% CI, 1.01-4.27), male gender (OR=9.33; 95% CI, 4.53-19.22), cardiac arrhythmia (OR=3.18; 95% CI, 1.19-8.15) and high consumption of energy drinks (OR=2.63; 95% CI, 1.30-5.31).

“Addressing the influence of psychophysical factors on stroke could constitute an additional therapeutic line in the primary prevention of stroke in the at-risk population and, as such, warrants further investigation,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Larry B. Goldstein

    Larry B. Goldstein

    Egido and colleagues report an association between higher levels of stress and type A personality and stroke risk. This case-control study was appropriately designed and analyzed, but has important limitations. The number of subjects was relatively small, the study was carried out in a single Spanish stroke unit and the results were not internally or externally validated. Studies of this type are also subject to unmeasured confounding, and additional studies are required to determine whether the results are generalizable to different populations. Even if the findings are replicated in other settings, association does not prove causality. Stress could be a risk marker for another, causally related factor. Additional support for the hypothesis could come from prospective cohort studies in which subjects are assessed for stress and personality type and then followed prospectively for the occurrence of stroke. The ultimate proof of causality, however, is experiment. A group of patients with high stress could be randomized to interventions to reduce stress vs. a control intervention. A reduction in stroke in the active intervention group that is also associated with a reduction in stress markers would not only help prove that stress leads to stroke, but provide evidence for an approach to effective treatment. Even in the absence of more definitive data, most patients would undoubtedly opt to reduce their levels of stress as much as possible. Accomplishing this in the modern world is not straightforward.

    • Larry B. Goldstein, MD, FAAN, FAHA
    • Professor of Medicine Director, Duke Stroke Center Duke University, Durham, NC Cardiology Today Board Member

    Disclosures: Dr. Goldstein reports no relevant financial disclosures.