NEW YORK (Reuters Health) – 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: Journal of the American Heart Association.
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.
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