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Depressive symptoms associated with higher risk of stroke and worse outcomes

Depressive symptoms associated with higher risk of stroke and worse outcomes


A new study suggests that people with a history of depressive symptoms have a 46% higher risk of stroke than those without a history of depression.

Data from the international INTERSTROKE study also showed that people who had depressive symptoms before stroke had worse outcomes, including significantly higher mortality in the first month after stroke.

These findings build on previous research on the association between depression and stroke. one study showed a higher risk of stroke among people with more depressive symptoms, another We found that exacerbation of depression may precede stroke in older people.

Dr. Robert Murphy

“Depression is an important risk factor for acute stroke and a potentially modifiable factor for the global burden of stroke.” Medscape Medical News“The study found that even mild depressive symptoms were associated with an increased risk of stroke. This adds to the literature that the entire range of depressive symptoms is associated with an increased risk of stroke.” increase.”

Here are the findings: publish online March 8th neurology.

risk of serious stroke

For analysis, researchers collected data on 26,877 cases and controls from 32 countries who participated in INTERSTROKE, the first international case-control study of acute stroke risk factors. Participants were recruited between 2007 and 2015 and completed a series of questionnaires on stroke risk factors, including measures of depressive symptoms experienced during the previous 12 months.

After adjusting for occupation, education, wealth index, diet, physical activity, alcohol consumption, and smoking history, having pre-stroke depressive symptoms was associated with higher odds of acute stroke (adjusted odds ratio ) [aOR]1.46; 95% confidence interval [CI]1.34–1.58), including both intracerebral hemorrhage (aOR, 1.56; 95% CI, 1.28–1.91) and ischemic stroke (aOR, 1.44; 95% CI, 1.31–1.58).

The risk of stroke increased with increasing severity of depression, but even those with mild depression had a 35% increased risk (aOR 1.35; 95% CI 1.19 – 1.53).

The increased risk was maintained even after further adjustment for diabetes, hypertension, atrial fibrillation, body mass index, work, home, and financial stress.

This association was consistent across geographic regions and age groups, but was stronger in men and those without hypertension.

“This study examines different components of depression and demonstrates that an association with acute stroke exists and that a biological gradient emerges with increasing burden of depressive symptoms associated with increased risk of mild disease.” , identified across the spectrum of moderate and severe depressive symptoms,” Murphy said.

Mediating effects of antidepressants?

Pre-stroke depressive symptoms were not associated with a higher likelihood of worse stroke severity, although worse outcomes (P. < .001) and higher mortality (10% vs 8.1%; P. = .003) 1 month after stroke.

In a subgroup analysis, researchers found no association between depressive symptoms and stroke risk in patients taking antidepressants.

Although causality cannot be inferred from these findings, “this subgroup analysis suggests that the increased risk of stroke in depressed patients may be mitigated if they receive appropriate treatment.” ,” says Murphy. “This is an area that requires further investigation.”

The mechanisms linking depression and stroke are unknown, but these findings provide strong evidence that this link exists, Murphy said.

“After adjusting for potential confounders in a continuous model and adjusting for conventional cardiovascular risk factors, there was a consistent association between depressive symptoms and stroke, and an independent association between depression and stroke. I have identified that there is a high possibility that

question remains

comments on the study of Medscape Medical Newssaid Daniel T. Lackland DrPH, professor in the Department of Neurology, Division of Translational Neuroscience and Population Studies at the South Carolina Medical College in Charleston, said there is a growing body of research into the link between stroke and depression.

“Depression may be a risk factor for stroke in this case,” said Lackland, who was not involved in the study. It suggests that it may provide additional benefits beyond that, in this case reducing the risk of stroke.”

However, as with any observational study, it is important that there may be confounding factors that may provide alternative explanations for the findings.

“Additionally, it is often difficult to accurately assess depression in all individuals, especially those who have had a stroke,” Lackland said. Although treatment for depression has been suggested to reduce risk, traditional stroke risk factors, including hypertension, [be] Recognize and treat continuously[ed] with high rigor. ”

neurologyPublished online on March 8, 2022. overview

The INTERSTROKE study was funded by the Canadian Institutes of Health Research, the Canadian Heart and Stroke Foundation, the Canadian Stroke Network, the Swedish Research Council, the Swedish Heart and Lung Foundation, AFA Insurance, and the Health and Medical Committee of the Regional Executive Board. Also AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), Merck Sharp & Dohme, Swedish Heart and Lung Foundation, Chest Heart & Stroke Scotland, and Stroke Association (UK). Murphy and Lackland have not reported any related financial relationships.

Kelly Whitlock Burton is Medscape Medical News, It covers neurology and psychiatry.

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