Stress and Stroke Risk

What is stress?

Stress is your body’s response to outside pressures or demands, called stressors. Your body responds to stressors by releasing chemicals and hormones into your blood, causing your heart to beat faster, your blood pressure to rise, and your muscles to tense. This physical response gives you more energy and strength to deal with the stressor. Once the stress or disappears or you have adapted to it, the body usually goes back to normal. However, extreme stress or stress over long periods of time (called chronic stress) can damage your emotional and physical health. Common symptoms of chronic stress include trouble sleeping, tiredness, headaches, backaches, upset stomach, irritability, and depression.

How does stress affect my stroke risk?

Stress is associated with high blood pressure and atherosclerosis, both strong risk factors for stroke. People who experience more stress and are less able to cope with it emotionally and physically are more at risk for stroke. One recent study of more than 20,000 people (57% were women) who had never had a stroke or heart disease found that stress was associated with an increased stroke risk, even after taking into account other stroke risk factors.

Researchers are divided as to exactly how stress affects stroke risk, but there is evidence that stress can affect your stroke risk in two ways:

First, stress can affect your stroke risk by how you behave in response to stressful situations. Some people under stress tend to engage in unhealthy coping behavior that only makes the stress worse and can make them more sensitive to further stress. If you smoke or eat or drink too much in response to stress, you increase your risk of high blood pressure, heart disease, and stroke.

Second, stress can affect your risk of stroke by how your body responds to stress. When your blood pressure rises in response to stress, your blood vessels expand to accommodate the increase in blood flow. Usually, once the stressful condition disappears or you have adapted to it, your blood pressure and blood vessels go back to normal. However, if the stress doesn’t disappear (it’s long-term or chronic) or happens repeatedly, the sudden spikes in blood pressure can damage your blood vessels, the same way as if you had persistent high blood pressure.

Repeated or long-lasting blood pressure spikes may result in blood vessel wall damage and atherosclerosis, which can cause a blocked-vessel (ischemic) stroke. A study of 254 postmenopausal women aged 50 to 60 found that strong elevations in blood pressure in response to stress may eventually impair the blood vessel wall’s ability to expand. A 4-year study of 726 adults (59% were women) aged 59 to 71 found that high levels of anxiety for a long period of time may increase the hardening (atherosclerosis) of the carotid arteries in your neck.

How someone’s blood pressure reacts to stress varies from person to person. Studies have found that people who have above-average blood pressure spikes in response to stress may be at higher risk for stroke than those with less reactive blood pressures.

Causes of Stress

What are the most common causes of stress for women?

Each woman experiences stress differently. What is be stressful for you may be exciting or motivating to other women. For example, some people are terrified of speaking in public, while others find it exciting. That being said, the most common sources of stress for women include work, home, and financial worry, and major life events such as divorce or the death of a loved one.

Work

In the US, 60% of women workers say their job is their number one stressor. Work-related stress can affect your risk of stroke by leaving you little time or motivation to participate in activities to improve your health. Research shows that women with demanding jobs are less likely to exercise and more likely to smoke and consume high-fat foods. High-strain jobs have also been associated with increased blood pressure.

There is also evidence that losing a job may be associated with an increased stroke risk. One study of more than 4000 adults (about 50% were women) with an average age of 55 years found that those who lost their job had nearly twice the risk of stroke compared to those who did not lose their job.

Home

When home responsibilities are added to the demands of work, levels of the stress hormone norepinephrine go up, as does blood pressure. Working mothers, whether married or single, experience higher stress levels than women without children. Studies show that blood pressure in working mothers with demanding jobs but little decision control may remain high even when they get home after work.

Major Life Events

Divorce and the death of a loved one are two of the most stressful events in a woman’s life. A Swedish study of more than 118,000 adults found that the risk of stroke increased for both women and men during the first years after a divorce or the death of a spouse.

Social and Economic

A person’s level of income and education as well as neighborhood environment can all be a source of chronic stress. These circumstances may also reduce your access to health care and health improvement facilities, such as gyms, and may limit the ways in which you’re able to respond to some stressors, such as the dual demands of a job and raising a child.

Controlling Stress to Prevent Stroke

Can preventing or managing stress lower my risk of stroke?

How you perceive a potentially stressful situation and how you respond to it, both emotionally and physically, determines how stress affects your health. It is impossible to completely avoid or eliminate stress in your life, and some stress is actually good for you, helping you to meet a challenging deadline or even avoid a falling object. It is the frequent or chronic stress that takes its toll on your health. This is why learning to cope with stress is more important than trying to prevent it altogether.

The strategies you use to manage your physical and behavioral response to stress—like exercising, relaxing, good nutrition, and not smoking—can have a lasting benefit on your overall health. A 7-year study of more than 20,000 adults (57% were women) found that those who adapted better to stressful events had a lower risk of stroke than those who had a harder time adapting, suggesting that the better you’re able to manage your response to stress, the more your health will benefit.16

How can I manage my stress?

There are a variety of ways to reduce and manage your physical and emotional response to stress:

Identify your stressors -The first step in learning how best to manage your stress is to identify the major sources of stress in your life, when they tend to happen, and how you react to each stressor. You can try keeping a stress diary in which you write down situations where you’ve felt stressed, the circumstances leading to them, and how your responded.

Recognize stress you can control and can’t control – Ask yourself if this is a stressor you can avoid, such as turning the TV news off if it’s only making you anxious. If you’re stressed about something out of your control, such as a natural disaster or an act of terrorism, change how you react to it by finding healthy and positive ways of coping with it physically and emotionally, including educating yourself about the current situation and making plans on what precautions you can take.

Exercise – Healthy exercise, such as walking, is the natural stress reliever; it reduces the amount of stress hormones that your body releases in response to stressful situations. Exercise can help you relax and improve your sleep, especially when done 3 to 6 hours before bedtime to allow your body enough time to cool down and relax.

Relaxation – Relaxation exercises involve the flexing and releasing of major muscle groups. Breathing exercises in which you consciously slow and deepen your breathing to help you relax also helps to reduce stress. Start by taking a deep breath and releasing it as you count to 10.

Sleep – You should try to get 6 to 8 hours of sleep a night. Lack of sleep can increase the level of stress hormones.

Healthy diet – Good nutrition can help you deal with the effects of stress.

Social support – Finding social support either from friends and family or through a support group can be helpful. People with good social support report less stress compared to those without a good support network.

Time to yourself – Women tend to put others before themselves. Remember to make some time for yourself, especially when you’re feeling stressed, to relax and replenish energy. Learn to say “No,” even if only to take enough time off for a long, hot bath.

Avoid unhealthy response to stress – Abusing alcohol, tobacco, or food doesn’t help with stress; it only makes it worse.

Counseling – If you need further help dealing with stress, consider counseling (individually or in group therapy) to learn how to reduce your stress symptoms and improve your health.

For More Information

Medline Plus – Managing Stress
www.nlm.nih.gov/medlineplus/tutorials/managingstress/htm/index.htm

American Heart Association – How Can I Manage Stress?
www.americanheart.org/downloadable/heart/110167971464923%20HowCanIManageSt

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