The risk of stroke and mini-strokes, also known as transient ischemic attacks (TIA), has been a stress factor on the American landscape for many years. A recent study using data from the Multi-Ethnic Study of Atherosclerosis (MESA) has published data claiming that persons between the ages of 45 and 84 years have higher risk factors when particular psychological conditions are present. Those factors are feelings of hostility, symptoms of depression and chronic stress. In America, the number of strokes that occur may be declining, but psychological stress factors continue to increase the individual risk.
The decade-long study covered six U.S. cities: Saint Paul, Minn.; New York City, N.Y.; Baltimore, Md.; Los Angles, Calif.; Chicago, Ill.; and Forsyth County, N.C., in which 6,749 candidates were evaluated using questionnaires. None of the participants displayed signs of cardiovascular conditions at the beginning of the research period. Ratings of chronic stress and depression were evaluated during the initial two years of recruitments, and subjects were then observed for an another 8.5 to 11 years.
Three stress factors were major contributors to the increased risk of stroke. Feelings of hostility, defined as a negative view of the world or a person’s cynical expectations of others, depression and chronic stress problems. Chronic stress problems consist of personal health issues, finances, relationships, ability to work, or health problems of others close to the subjects.
People in the study who had the lowest psychological scores displayed a high percentage of risk of stroke or TIAs. Americans subject to stress factors in the study for depression reached a high of 89 percent, and the risk was 59 percent for chronic stress. Associate professor at the University of Minnesota, Dr. Susan Everson-Rose, was the lead author of the study. She explained that the current focus on traditional risk factors such as smoking, blood pressure, cholesterol levels, and other factors are significant, but a study of this nature illustrates that psychological attributes are also of equal importance.
The Journal of the American Medical Association reports the overall death rates for stroke victims has declined in the last two decades. From 1987 to 2011, stroke rates of persons in this country between the ages of 45 and 65 declined. The likelihood of dying because of a stroke decreased during this period also.
Lower stroke rates of those 65 and over were mainly driven by better, widespread control of the risk factors associated with it, including atrial fibrillation, diabetes, high blood pressure, smoking and high cholesterol. Medication controls for hypertension, pills for constraining cholesterol levels and a strong decrease in smoking rates contributed to the lower of death rates.
Better treatment for strokes and institutionalized stroke centers in U.S. hospitals were acknowledged as significant factors in survival rates. However, it has also been noted by the University of Miami’s Miller School of Medicine that this trend has the possibility of reversal with the next aging generation’s larger population of people with obesity, sedentary behavior and poor nutrition.
There were 14,357 participants in the 22 year-long JAMA study, and only seven percent, or 1,051 persons, suffered a stroke. 929 strokes were caused by an interruption of blood flow to the brain. The other portion of strokes, 140, were the result of hemorrhagic stroke, or a widespread bleeding in the brain. During the study period, 18 patients were impaired with both types of stroke. Strokes continue to cause stress for Americans and due to the risk factors faced by the new generation of elderly, they will do so for many more years.
By Andy Towle