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High Stress Raises Risk of Fatal Stroke
Cope With Stress Rather Than Reduce Stress

Jeanie Lerche Davis WebMD Medical Reviewed By Brunilda Nazario, MD
Friday, March 14, 2003

There's more evidence it pays to reduce stress in your life -- or to learn to cope with it better. Intense, daily stress may increase your risk of having a fatal stroke.

A large, 13-year study shows that people reporting weekly stress, and high levels of stress were most likely to have a fatal stroke. People who said they had high stress levels had almost double the risk of fatal stroke. Those who said they felt stress on a weekly basis had a 50% increased risk of fatal stroke compared with the least-stressed people.

Reducing stress? Is that even possible? "To 'take it easy' is not easy and not necessarily the best advice," says lead author Thomas Truelsen, MD, with the Institute of Preventive Medicine in Copenhagen.

In fact, it's the effects of stress on our lifestyle -- making us smoke, eat unhealthy foods, drink alcohol, get less physical activity -- that are "worth paying attention to," Truelsen tells WebMD. "When there is stress in our lives, we need to examine carefully if it is changing our lifestyle in a less healthy way, taking it in a less healthy direction."

Because stress was linked with so many unhealthy behaviors, researchers couldn't determine if stress alone was an independent risk factor. In fact, they found no significant link between stress and nonfatal strokes.

Their study appears in the current issue of Stroke: Journal of the American Heart Association.

In it, Truelsen and colleagues outline their study of 5,604 men and 6,970 women from 1981 to 1994. From 1981 to 1983, each was asked about the intensity of their stress -- whether it was high, moderate, light, never/hardly ever. They were also asked about stress frequency -- whether daily, weekly, monthly, or never/hardly ever.

Stress was defined as the sensation of tension, nervousness, impatience, anxiety, or sleeplessness.

In 13 years of follow-up, 929 of the study participants had suffered their first stroke; 22% of those were fatal within 28 days. After researchers adjusted for factors that might increase the risk of stroke, they found people with high levels of stress had an almost double risk of fatal stroke compared with people without stress.

Previous studies have shown that men who have intense reactions to stress were at greater risk of stroke than men who were better educated, Truelsen states. Coping mechanisms -- and feeling in control of the situation -- may be important factors in reducing the effects of stress, he explains.

"More educated people will often be more in control of their jobs and consequently more likely to be able to cope with stressful situations in the job setting compared with people with low-control jobs," he writes.

Indeed, "whether reducing stress alone can reduce risk of dying from stroke -- or risk of stroke itself -- is uncertain," says Michael Frankel, MD, chief of neurology at Grady Health System and professor of neurology at Emory University School of Medicine in Atlanta.

He agreed to comment on Truelsen's study for WebMD.

High blood pressure is the strongest predictor of stroke and must be taken seriously, says Frankel. "Not only is high blood pressure a risk for stroke, lowering it reduces risk of stroke and heart attack. We know that. We know that smoking is a risk factor for stroke, and stopping smoking reduces your risk of heart attack and stroke."

Frankel's advice on reducing risk of stroke: get blood pressure under control, quit smoking, control diabetes, lower high cholesterol, get exercise, and lose weight.

Developing a healthier lifestyle amid the stress -- rather than trying to reduce stress -- may be the most important lesson

SOURCES: Stroke, April 2003. News release, American Heart Association. Thomas Truelsen, MD, Institute of Preventive Medicine, Copenhagen. Michael Frankel, MD, chief of neurology, Grady Health System; professor of neurology, Emory University School of Medicine, Atlanta.
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