title: Is psycho-physical stress a risk factor for stroke? A case-control study.
abstract: BACKGROUND
  Chronic stress is associated with cardiovascular diseases, but the link with stroke has not been well established. Stress is influenced by life-style habits, personality type and anxiety levels. We sought to evaluate psycho-physical stress as a risk factor for stroke, while assessing gender influences.
  
  
  METHODS
  Case-control study. cases: patients (n=150) aged 18-65, admitted consecutively to our Stroke Unit with the diagnosis of incident stroke.
  
  
  METHODS
  (n=300) neighbours (paired with case ±5 years) recruited from the census registry.
  
  
  METHODS
  socio-demographic characteristics, vascular risk factors, psychophysical scales of H&R (Holmes & Rahe questionnaire of life events), ERCTA (recall scale of type A behaviour), SF12 (QoL scale), GHQ28 (general health questionnaire). Statistical analyses included conditional multiple logistic regression models.
  
  
  RESULTS
  Mean age was 53.8 years (SD: 9.3). Compared with controls, and following adjustment for confounding variables, significant associations between stroke and stress were: H&R values >150 OR=3.84 (95% CI 1.91 to 7.70, p<0.001); ERCTA (values >24) OR=2.23 (95% CI 1.19 to 4.18, p=0.012); mental SF12 (values >50) OR=0.73 (95% CI 0.39 to 1.37, p=0.330); psychological SF12 (values >50) OR=0.66 (95% CI 0.33 to 1.30, p=0.229), male gender OR=9.33 (95% CI 4.53 to 19.22, p<0.001), high consumption of energy-providing beverages OR=2.63 (95% CI 1.30 to 5.31, p=0.007), current smoker OR=2.08 (95% CI 1.01 to 4.27, p=0.046), ex-smoker OR=2.35 (95% CI 1.07 to 5.12, p=0.032), cardiac arrhythmia OR=3.18 (95% CI 1.19 to 8.51, p=0.022) and Epworth scale (≥9) OR=2.83 (95% CI 1.03 to 7.78, p=0.044).
  
  
  CONCLUSIONS
  Compared with healthy age-matched individuals, stressful habits and type A behaviour are associated with high risk of stroke. This association is not modified by gender.
authors.affiliation: Department of Neurology, Hospital Clinico Universitario San Carlos, Avda/ Martin Lagos, s/n. 28040 Madrid, Spain. jegidoh@yahoo.com
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Egido
authors.forename: Olga
authors.initials: O
authors.lastname: Castillo
authors.forename: Beatriz
authors.initials: B
authors.lastname: Roig
authors.forename: Isabel
authors.initials: I
authors.lastname: Sanz
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Herrero
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Garay
authors.forename: Ana María
authors.initials: AM
authors.lastname: Garcia
authors.forename: Manuel
authors.initials: M
authors.lastname: Fuentes
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernandez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics; D013030:Spain / Q000453:epidemiology; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires