Stroke Risk May Hit a High When Mood is Low

Study found a 40 percent greater chance of trouble among depressed people

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By
HealthDay Reporter

WEDNESDAY, April 28, 2004 (HealthDayNews) -- Stroke risk may go up when people feel most down, researchers report.

A new study found the risk of stroke rose by about 40 percent in sad or depressed individuals compared with happier people.

"If someone is depressed they should be treated for psychiatric reasons, but early treatment may also be beneficial in terms of stroke and heart disease, too," said lead researcher Dr. Ji Chong, a stroke expert at Columbia University's Neurological Institute in New York City.

The findings were presented April 28 at the American Academy of Neurology's annual meeting in San Francisco.

Numerous studies have suggested strong links between depression and increased cardiovascular risk, "specifically heart attacks and deaths from heart attack," Chong said. Other studies have also shown there may be associations between mood and stroke.

In this most recent study, the Columbia researchers examined the link between stroke incidence and feelings of sadness or depression in 3,300 adults living in an ethnically diverse New York City neighborhood.

As part of a standard psychiatric questionnaire, each of the participants was periodically asked, "What has your mood been like this past week?" The researchers also tracked participants' incidence of stroke over a five-year period.

"After adjusting for all the other usual risk factors for stroke, such as high blood pressure, cardiac diseases, etc., there was still an independent association between depressed mood and stroke," Chong said. Overall, stroke risk rose 40 percent in those who admitted to recent feelings of sadness or depression, compared to those who did not. The severity of depressed mood appeared to have no influence on the likelihood of stroke, however.

The association between stroke and feeling blue was especially pronounced in whites compared with blacks or Hispanics. However, Chong believes that finding reflects a flaw in the study methodology rather than any significant race-based difference.

Dr. J.D. Bartleson, a neurologist at the Mayo Clinic in Rochester, Minn., said the study "increases my interest in asking about depression and probably intervening in patients who have an increased risk of stroke based on their history of depression."

He and other experts remain puzzled, however, as to the mechanisms by which a person's emotional state can influence his or her cardiovascular health. One theory is that stress and depression trigger inflammation of the blood vessels -- a key factor in upping risks for stroke and heart attack. Or the culprit could be hormonal -- "adrenalin, epinephrine, norepinephrine or some other stress-related chemical that would be likely to affect vessels," Bartleson explained.

Whatever the underlying cause, "if you knew the mechanism then maybe in addition to treating their depression you might also give them something that would get at the mechanism," he said.

Chong agreed. "With depression, it's pretty well established that there's a hormonal system that may be out of balance," she said. "There are a lot of multiple effects that could lead to vascular issues." Further studies are planned to examine just those issues, she added.

In a separate study, presented April 27 at the conference, researchers reported that a drug used to lower blood pressure can also limit the amount of damage occurring in the brain in the days, months and years after a stroke.

A French team led by Dr. Carole Dufuoil of the Institut National de la Sante et de la Recherche Medicale in Paris had 226 stroke survivors take either the antihypertensive drug perindopril (Aceon) or a placebo for three years after their stroke.

Using magnetic resonance imaging (MRIs), they looked specifically for evidence of "white matter lesions" -- brain lesions indicative of brain damage and cognitive decline.

"Overall, the volume of new white matter lesions in the patients who took the placebo was five times higher compared to those who received the blood pressure medication -- and more than 7.5 times higher for those patients who had severe white matter lesions upon entry [to the study]" Dufuoil said in a statement. Based on the findings, she concluded that perindopril, one of a family of antihypertensive drugs called ACE inhibitors, "stops or delays" post-stroke brain damage in stroke survivors.

The study received funding from drug maker Servier, which markets perindopril in Europe under the brand name Coversyl. Additional funding came from the Health Research Council of New Zealand and the National Health and Medical Research Council of Australia.

More information

For more information on spotting and controlling depression, visit the National Institute of Mental Health. Details on the causes, signs and treatment of stroke can be found at the American Stroke Association.

SOURCES: Ji Chong, M.D., Clinical Stroke Fellow, Neurological Institute, Columbia University, New York City; J.D. Bartleson, M.D., Mayo Clinic, and associate professor, neurology, Mayo Medical School, Rochester, Minn.; April 28, 2004, presentations, American Academy of Neurology annual meeting, San Francisco

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