Key result
Psychological stress is linked to a ~46% higher stroke risk.
Why the study?
Psychological stress has been increasingly recognized as a potential risk factor for stroke, but the strength and consistency of this association remained uncertain.
Does exposure to broad psychological stress increase the risk of stroke in individuals without a history of depression?
Meta-Analysis (n=950,000)
Does exposure to broad psychological stress increase the risk of stroke in individuals without a history of depression?
Psychological stress is significantly associated with a 46% increased risk of stroke, highlighting the importance of psychosocial factors in cardiovascular and cerebrovascular risk assessment.
Answers are grounded in this paper and cite their sources.
Psychological stress was associated with higher stroke risk; leaves open causality and whether interventions alter outcomes.
Background Psychological stress has been increasingly recognized as a potential risk factor for stroke, but the strength and consistency of this association remained uncertain. This systematic review and meta-analysis aims to determine the overall association between broad psychological stress and broad stroke risk. Methodology Systematic searches of PubMed, Scopus, Web of Science, and OVID databases from 1990 to March of 2025. These searches utilized a strategy combining subject headings and keywords related to psychosocial risk factors and stroke. Twenty-eight studies met inclusion criteria (23 prospective cohort and 5 case-control), comprising over 950,000 participants. We excluded studies involving participants with a history of depression. Stroke was broadly defined to include ischemic, hemorrhagic, subarachnoid, TIA, and unspecified subtypes. Results Our meta-analysis of 23 prospective cohort studies found that individuals exposed to psychological stress had a 46% higher risk of experiencing stroke (HR = 1.46; 95% CI: 1.29–1.66; P < 0.01). Initial analysis revealed substantial heterogeneity ( I 2 = 82%), which was significantly reduced to 39% (HR = 1.45; 95% CI: 1.32–1.59; P = 0.02) after a sensitivity analysis. Analysis of five case-control studies yielded a pooled odds ratio (OR) of 1.10 (95% CI: 1.01–1.20; P < 0.01), also indicating a modest but significant elevation in stroke risk; however, heterogeneity remained high ( I 2 = 92%). Sex-stratified analysis showed comparable increases in stroke risk for males (HR = 1.33; 95% CI: 1.19–1.49) and females (HR = 1.44; 95% CI: 1.07–1.95), with no statistically significant subgroup difference ( P = 0.61). Conclusion Psychological stress is significantly associated with an increased risk of fatal stroke, though publication bias and study heterogeneity highlight the need for cautious interpretation. Further research should aim to address methodological variability and selective reporting to refine our understanding of this relationship.
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Khalifa et al. (2025) conducted a meta-analysis in Stroke (n=950,000). Psychological stress vs. No or low psychological stress was evaluated on Risk of experiencing stroke (prospective cohort studies) (HR 1.46, 95% CI 1.29-1.66, p=<0.01). Individuals exposed to psychological stress had a 46% higher risk of experiencing stroke compared to those without such exposure (HR 1.46, 95% CI 1.29-1.66, P < 0.01).
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