Was it overweight? Of unhealthy nutrition? Or is it the constant stress at work? Anyone who has survived a stroke worries a lot afterwards. The causes of the disease, however, can often not be clearly determined. Several factors usually come together, and stress can certainly play a role. The neurologist Professor Armin Grau from Ludwigshafen explains what is known from studies on risk factors. The 63-year-old (picture: oh) has been chief physician for neurology at the Ludwigshafen Clinic since 2003.
Is it true that stress can trigger a stroke?
A number of studies have shown that very high levels of mental stress can actually be associated with an increased risk of stroke. But you have to realize that the increase in risk that results from this is not particularly great compared to other risk factors. Meta-analyses, i.e. reviews that summarize other studies, have shown that the risk is about a third higher.
That’s not a little.
It depends what you compare it to. For example, high blood pressure is a much more powerful factor, and atrial fibrillation even more so.
What kind of stress is particularly dangerous – being overwhelmed at work, relationship crises, money worries?
You don’t really know. The meta-analysis summarized general stress and work-related stress. She did not do any individual analyses. A distinction is made between positive stress, i.e. stress that has a stimulating effect and is associated with satisfaction, and stress that we perceive as distressing. Presumably it is only the latter that increases the risks.
Should a healthy person also expect a seizure if they have been under a lot of stress for a long time?
It is usually the case that stress is added to other risk factors, which in total are usually much more significant. These are primarily high blood pressure, diabetes, high cholesterol, smoking and atrial fibrillation. But sometimes we also have younger people in whom one does not find any classic risk factors and development mechanisms. The question in such cases is: why did these people have a stroke, why not another disease? Anyone who is constantly under high voltage generally has an increased risk of illness. It is the doctor’s job to check whether there are other factors, perhaps rare ones, which, in addition to stress, lead to the brain being affected by a circulatory disorder.
Why does stress matter at all?
That is not fully clear. Stress also means an increase in blood pressure, whether continuous or momentary in a particularly stressful situation. This can also increase the risk of stroke. Otherwise, the mind and body are generally closely connected. There are a number of mechanisms that we do not yet fully understand.
It is said that tragic news can also trigger a stroke.
That too has been investigated. One speaks here of “stressful life events”, i.e. very stressful life events. Some studies have found a connection, others have not. A meta-analysis did not find any statistically significant connection here. So this is still an unanswered question in science with conflicting results. But in individual cases it is possible.
What else can trigger a stroke?
Basically, you have to distinguish between risk and trigger factors. Risk factors are those that are present continuously or over a long period of time, i.e. high blood pressure, diabetes, obesity. But the question is why the stroke occurs at a specific point in time. Many studies have therefore dealt with the immediate triggers, the trigger factors. These are, for example, recent infections, operations and accidents.
Do infections play a major role?
Yes. It is known that the risk of a stroke is clearly increased in the first four weeks after an infection. Above all, respiratory infections play a role, but also urinary tract infections and other sources of infection in the body. Any infection triggers an inflammatory response, and this is accompanied by activation of the coagulation system. This results in an increased suitability for thrombosis for a shorter period of time. It is also known that non-infectious inflammatory diseases and autoimmune diseases associated with inflammation lead to an increased risk of stroke.
Does Covid-19 also belong to this?
Absolutely. Covid plays exactly the same role here as other infections. It has been known since the 19th century that there is a connection between infections and stroke. For example, people like Sigmund Freud worked on it before he became a psychiatrist. The connection was later forgotten, but has been researched again since the 1980s.
Does a flu shot protect against strokes?
This is an exciting topic. Many studies have shown that influenza vaccination reduces the risk of stroke. In science, however, it is disputed whether this is a real, i.e. causal, effect or an indirect consequence. People who are more health-conscious are also more likely to be vaccinated. Therefore, the lower risk of stroke could also be due to the healthier lifestyle. This is an unsolved mystery. I’m curious to see what happens when you examine patients with and without a Covid-19 vaccination for the risk of stroke. This is going to be an exciting thing.
This is important
– Exercise: Regular physical activity strengthens the cardiovascular system. Recommended activities include hiking, jogging, swimming and cycling. Anyone who has not exercised for a long time or has a chronic illness should seek medical advice beforehand.
– Diet: Lots of fruit, vegetables and whole grain products, but relatively little salt, sugar, animal fat and red meat: Those who base their diet on these principles are doing most things right. This can influence cholesterol, blood sugar and blood pressure levels.
– No smoking: Smokers have a greatly increased risk of stroke. Anyone who manages to give up cigarettes and the like can reduce it significantly: Five years after stopping smoking, the risk drops to that of a non-smoker. You should also be careful with alcohol.
– Avoiding stress: Relaxation techniques and exercise help to reduce tension. Yoga, meditation or progressive muscle relaxation can contribute to this.
– Health check-ups: from the age of 35, people with statutory health insurance can have a medical check-up every three years. The examination includes a blood and urine test. The aim is to identify health risks and the most common diseases (e.g. diabetes, cardiovascular problems) as early as possible.
– Monitor blood pressure: Anyone who tends to have high blood pressure should measure it regularly at home. A blood pressure diary can help to compare the values.