title: Anxiety and the Risk of Stroke: The Rotterdam Study.
abstract: OBJECTIVE
  It is unclear whether anxiety is a risk factor for stroke. We assessed the association between anxiety and the risk of incident stroke.
  
  
  METHODS
  This population-based cohort study was based on 2 rounds of the Rotterdam Study. Each round was taken separately as baseline. In 1993 to 1995, anxiety symptoms were measured using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). In 2002 to 2004, anxiety disorders were assessed using the Munich version of the Composite International Diagnostic Interview. Participants were followed up for incident stroke until January 2012.
  
  
  RESULTS
  In the sample undergoing HADS-A (N=2625; mean age at baseline, 68.4 years), 332 strokes occurred during 32 720 years of follow-up. HADS-A score was not associated with the risk of stroke during complete follow-up (adjusted hazard ratio, 1.02; 95% confidence interval, 0.74-1.43; for HADS-A≥8 compared with HADS-A <8), although we did find an increased risk after a shorter follow-up of 3 years (adjusted hazard ratio, 2.68; 95% confidence interval, 1.33-5.41). In the sample undergoing the Munich version of the Composite International Diagnostic Interview (N=8662; mean age at baseline, 66.1 years), 340 strokes occurred during 48 703 years of follow-up. Participants with any anxiety disorder had no higher risk of stroke than participants without anxiety disorder (adjusted hazard ratio, 0.95; 95% confidence interval, 0.64-1.43). We also did not observe an increased risk of stroke for the different subtypes of anxiety.
  
  
  CONCLUSIONS
  Anxiety disorders were not associated with stroke in our general population study. Anxiety symptoms were only related to stroke in the short term, which needs further exploration.
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., M.J.B., A.H., H.W.T., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), Radiology (M.A.I.), Child and Adolescent Psychiatry (H.W.T.), and Psychiatry (H.W.T.), Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Marileen L P
authors.initials: ML
authors.lastname: Portegies
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., M.J.B., A.H., H.W.T., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), Radiology (M.A.I.), Child and Adolescent Psychiatry (H.W.T.), and Psychiatry (H.W.T.), Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Bos
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., M.J.B., A.H., H.W.T., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), Radiology (M.A.I.), Child and Adolescent Psychiatry (H.W.T.), and Psychiatry (H.W.T.), Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., M.J.B., A.H., H.W.T., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), Radiology (M.A.I.), Child and Adolescent Psychiatry (H.W.T.), and Psychiatry (H.W.T.), Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., M.J.B., A.H., H.W.T., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), Radiology (M.A.I.), Child and Adolescent Psychiatry (H.W.T.), and Psychiatry (H.W.T.), Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Henning W
authors.initials: HW
authors.lastname: Tiemeier
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., M.J.B., A.H., H.W.T., M.A.I.), Neurology (M.L.P.P., P.J.K., M.A.I.), Radiology (M.A.I.), Child and Adolescent Psychiatry (H.W.T.), and Psychiatry (H.W.T.), Erasmus MC, Rotterdam, The Netherlands. m.a.ikram@erasmusmc.nl.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
keywords: anxiety; epidemiology; stroke