Psychological Distress Linked to Fatal Ischemic Stroke in

Middle-Aged Men

NEW YORK (Reuters Health) Jan 03 - Psychological distress is

predictive of fatal ischemic stroke in middle-aged men, but not of
nonfatal stroke or transient ischemic attack (TIA), UK researchers
report in the January issue of Stroke.

Dr. Shah Ebrahim, from the University of Bristol, and colleagues

collected data on 2201 men, 45 to 59 years of age, who participated in
phase II of the Caerphilly Study and completed the General Health
Questionnaire, which assesses the level of psychological distress. The
Caerphilly Study is a community-based study of cardiovascular
disease and related outcomes.

Among these men, 22% had scores on the General Health

Questionnaire indicating psychological distress. During 14 years of
follow-up, in the remaining cohort of 2124 men, there were 130
strokes, 17 fatal and 113 nonfatal, the researchers report.

"The relative risk of incident ischemic stroke was 1.45 for those who
showed symptoms of psychological distress compared with those who
did not," the researchers report. In the distressed subjects, the
relative risk of fatal stroke, nonfatal stroke and TIA was 3.36, 1.25
and 0.63, respectively. After adjusting for body mass index, systolic
blood pressure, smoking, heavy drinking, social class, and martial
status, the findings were unchanged.

The relative risk was attenuated when previous ischemic heart

disease, diabetes, respiratory disease, and retirement because of poor
health were considered.

The relative risk of fatal stroke declined to 2.56 when all confounding
factors were factored in. Dr. Ebrahim's group noted "a graded
association between degree of psychological distress and risk of fatal
ischemic stroke."

"The positive association between psychological distress and fatal

ischemic stroke is not readily explained," Dr. Ebrahim and colleagues
comment. "Psychological distress is debilitating, and the finding that
it may also increase risk of fatal stroke...indicates the need to better
understand the mechanisms of this effect and also to improve primary
prevention interventions for psychological distress in later life."
"The Caerphilly study is an excellent beginning, but the relationships
between psychological distress and cerebrovascular disease, stroke,
and stroke mortality deserve further investigation," Drs. Robert M.
Carney and Kenneth E. Freedland, from the Washington University
School of Medicine, St. Louis, note in their journal editorial.

"Whether treating depression can reduce the risk of stroke mortality

is not yet known. Thus, we strongly recommend that clinicians screen
for and treat clinically significant depression as a problem in its own
right, even if there is uncertainty as to whether treating depression
can reduce the risk of stroke mortality," they add.

Stroke 2002;33:000-000.

Psychosom Med 2001 Mar-Apr;63(2):210-5

The association between emotional well-being and the

incidence of stroke in older adults.

Ostir GV, Markides KS, Peek MK, Goodwin JS.

Department of Preventive Medicine and Community Health, Sealy

Center on Aging, University of Texas Medical Branch, Galveston
77555-1143, USA. gostir@utmb.edu

OBJECTIVE: Individuals with high levels of depressive symptoms have

an increased risk of many illnesses, including stroke. Measures of
depressive symptoms include questions about the presence of
negative affect, such as sadness, as well as the absence of positive
affect, such as happiness and optimism. We assessed whether positive
or negative affect, or both, predicted risk of stroke. METHODS: Data
were from a 6-year prospective cohort study of a population-based
sample of 2478 older whites and blacks from five counties in North
Carolina who reported no history of stroke at the baseline interview.
Baseline, in-person interviews were conducted to gather information
on sociodemographic, psychosocial, and health-related characteristics
of subjects. Thereafter interviews were conducted annually for 6
years. RESULTS: Increasing scores on the modified version of the
Center for Epidemiological Studies Depression Scale (CES-D) were
significantly associated with stroke incidence for the overall sample
(relative risk [RR] = 1.04 for each one-point increase, 95% confidence
interval [CI] = 1.01-1.09) over the 6-year follow-up period after
adjusting for sociodemographic characteristics, blood pressure, body
mass index, smoking status, and selected chronic diseases. Positive
affect score demonstrated a strong inverse association with stroke
incidence (RR = 0.74, 95% CI = 0.62-0.88). CONCLUSIONS:
Increasing scores on the modified CES-D are related to an increased
risk of stroke, whereas high levels of positive affect seem to protect
against stroke in older adults.

PMID: 11292267 [PubMed - indexed for MEDLINE]