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Stress resilience in male adolescents and subsequent stroke risk: cohort study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden. (Nuparc)
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. (Klinisk epidemiologi och biostatistik)
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. (Clinical Epidemiology and Biostatistics (Klinisk epidemiologi och biostatistik))ORCID iD: 0000-0002-3649-2639
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-9760-3785
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2014 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 12, p. 1331-1336Article in journal (Refereed) Published
Abstract [en]

Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2014. Vol. 85, no 12, p. 1331-1336
Keywords [en]
stroke
National Category
Neurology Psychiatry Surgery
Identifiers
URN: urn:nbn:se:oru:diva-35058DOI: 10.1136/jnnp-2013-307485ISI: 000345276400010Scopus ID: 2-s2.0-84896691316OAI: oai:DiVA.org:oru-35058DiVA, id: diva2:717549
Note

Funding Agency:

UK Economic and Social Research Council (ESRC) RES-596-28-0001 ES/J019119/1

Stiftelsen Olle Engqvist Byggmästare 

Örebro University 

Available from: 2014-05-15 Created: 2014-05-15 Last updated: 2018-07-22Bibliographically approved
In thesis
1. Life-course influences on occurrence and outcome for stroke and coronary heart disease
Open this publication in new window or tab >>Life-course influences on occurrence and outcome for stroke and coronary heart disease
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 156
Keywords
cardiovascular disease, stroke, risk factors, adolescence, stress resilience, adult infections, life-course epidemiology, cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-54254 (URN)978-91-7529-177-2 (ISBN)
Public defence
2017-03-10, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2017-01-03 Created: 2017-01-03 Last updated: 2018-01-13Bibliographically approved

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Bergh, CeciliaUdumyan, RuzanFall, KatjaNilsagård, YlvaAppelros, PeterMontgomery, Scott

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Bergh, CeciliaUdumyan, RuzanFall, KatjaNilsagård, YlvaAppelros, PeterMontgomery, Scott
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