Stroke Risk May Be High When Mood Is Low

Researchers Look For Causes

Stroke risk may go up when people feel most down, according to a report presented at the American Academy of Neurology annual meeting.

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," says lead researcher Dr. Ji Chong, a stroke expert at Columbia University's Neurological Institute in New York City.

Every year about 700,000 people in the US have a stroke, about a third of which are recurrent strokes. Today, there are an estimated 4.7 million stroke survivors in the US.

While 14 percent of people who have a stroke experience full recovery of physical function, 25 percent to 50 percent need some help with the activities of daily living such as dressing, bathing, or walking. About 50 percent suffer severe long-term effects such as paralysis.

Study Results Confirm Earlier Studies

Numerous studies have suggested strong links between depression and increased cardiovascular risk, "specifically heart attacks and deaths from heart attack," Dr. Chong says. 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," Dr. Chong says.

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 Caucasians compared with African Americans or Latino Americans.

However, Dr. Chong believes that finding reflects a study nuance rather than any significant race-based difference.

Scientists Interested in Causes

Dr. J.D. Bartleson, a neurologist at the Mayo Clinic in Rochester, Minn., says 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," Dr. Bartleson explains.

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 says.

Dr. Chong agrees. "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 adds.

Always consult your physician for more information.

Online Resources

American Heart Association

June 2004

Stroke Risk May Be High When Mood Is Low

Study Results Confirm Earlier Studies

Scientists Interested in Causes

Exercise Helps Prevent Strokes

Online Resources

Exercise Helps Prevent Strokes

Exercise not only can prevent a first stroke, it can also prevent second or third occurrences.

New guidelines from the American Heart Association say that 20 minutes or more of aerobic exercise three to seven times a week can help reduce the risk of recurrent strokes.

The guidelines, apparently the first of their kind, appear in Circulation: Journal of the American Heart Association.

"Everybody knows that exercise is good for you, and it has been shown that regular exercise is a way of controlling blood pressure, cholesterol, heart, lungs, all those sorts of things," says Dr. Steven Flanagan, at Mount Sinai Medical Center in New York City. 

"And, of course, these are all things that prevent you from having a stroke," he says. "We know that, [but] I'm not aware of any studies examining whether that type of exercise prevents stroke in people who have already had one."

According to the study authors, stroke care has typically emphasized the first few months after the stroke, with less attention to what came after, the belief being that most or all recovery of motor function happened in this earlier time period.

"The focus early on after a stroke is to re-teach an arm to work, but we also have to keep in mind that we should be encouraging just good overall cardiovascular fitness," Dr. Flanagan says.

"That's the value of this study," Dr. Flanagan says. "It makes us think about it. Now that we've gotten as far as we think we can go with rehab to function, let's get you doing something to keep you in shape."

Of course, one size does not fit all when it comes to an exercise routine after a stroke.

"Depending on what the limitations are, you have to be able to tailor your program accordingly," Dr. Flanagan points out. "Not everyone is going to be able to run on a treadmill, but they might be able to get on a bicycle, particularly a reclining one."

With this caveat in mind, the new guidelines recommend that stroke survivors do 20 to 60 minutes of aerobic exercise (such as walking, treadmill, and bicycle) three to seven days per week. The sessions do not have to be done all at once.

For strength training, the guidelines suggest at least one set of 10 to 15 repetitions using weights or resistances. Eight to 10 different exercises should be included in each session, and the sessions should be repeated two to three days a week.

Finally, the guidelines also recommend stretching and flexibility training before the aerobic or strength-training sessions two to three days a week. Balance and coordination exercises should also be done two to three days a week.

Regular aerobic physical activity increases your capacity for exercise. It also plays a role in both primary and secondary prevention of cardiovascular disease.

Physical inactivity is a major risk factor for heart disease and stroke and is linked to cardiovascular mortality.

Exercise can help control blood lipid abnormalities, diabetes, and obesity. Aerobic exercise also has an independent, modest blood-pressure-lowering effect for certain groups of people with high blood pressure.

Always consult your physician for more information.