Vivek Rai, MD

Lambiase MJ, Kubzansky LD, and Thurston RC. Prospective Study of Anxiety and Incident Stroke. Stroke. 2014

Long-standing anxiety disorder and anxiety symptoms have been associated with increased risk of coronary heart disease. Only a few studies have investigated role of anxiety in cerebrovascular disease. Lambiase and colleagues analyzed data of 6019 participants in First National Health and Nutrition Examination Survey followed for about 16 years. 

The authors report that anxiety symptoms at baseline were associated with increased risk of incident stroke after adjusting for standard biological and behavioral cardiovascular risk factors (hazard ratio=1.14, 95% CI: 1.03, 1.25). The increased risk persisted even after controlling for depression. Further exploratory analyses suggested increased prevalence of poor health behaviors especially smoking and physical activity in participants reporting anxiety symptoms.

This is the largest prospective database analyzed for link between anxiety symptoms and stroke risk. The study suggests that anxiety symptoms (not necessarily anxiety disorder) are an independent risk factor for ischemic stroke. Authors rightly point out that given anxiety is highly prevalent in population, assessing anxiety symptoms may contribute to developing more effective preventive and intervention strategies for reducing stroke risk. More research is needed to better understand physiologic effect of psychiatric symptoms. Further studies are also required to study whether treatment of anxiety disorders and subclinical anxiety can reduce the risk of cerebrovascular disease.