title: Stress resilience in male adolescents and subsequent stroke risk: cohort study.
abstract: OBJECTIVE
  Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.
  
  
  METHODS
  Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.
  
  
  RESULTS
  Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.
  
  
  CONCLUSIONS
  Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.
authors.affiliation: Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bergh
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden Department of Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Ruzan
authors.initials: R
authors.lastname: Udumyan
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden Department of Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Katja
authors.initials: K
authors.lastname: Fall
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Nilsagård
authors.affiliation: Department of Neurology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Appelros
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden Department of Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden Department of Epidemiology and Public Health, University College London, London, UK Cinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Scott
authors.initials: S
authors.lastname: Montgomery
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D055500:Resilience, Psychological; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013548:Sweden / Q000453:epidemiology