People who say they are highly stressed have more risk of having a fatal stroke than those who feel stress-free, researchers have found.
Stress is linked to other risk factors
Those who said they were highly stressed had an 89% higher risk of dying after having a stroke compared to those who were never, or hardly ever, stressed.
People who said they felt stress on a weekly basis also had a significant increased risk of a fatal stroke compared to those in the least stressed groups.
The Danish researchers say the link could be due to stressed people having other cardiovascular risk factors, such as being smokers, doing less exercise, being heavy drinkers and having high blood pressure.
The overall message we would give is to try to keep stress down, a varied diet, get some exercise and check your blood pressure
Eoin Redahan, Stroke Association
There was no significant effect of stress on non-fatal strokes.
Researchers from the Department of Neurology at Bispebjerg Hospital and the Institute of Preventive Medicine in Copenhagen, Denmark used data from the Copenhagen City Heart Study on 5,600 men and 6,970 women from 1981 to 1983.
People were asked how often they felt stressed, and how stressed they felt.
Stress was defined as the sensation of tension, nervousness, impatience, anxiety or sleeplessness.
People were followed for 13 years.
In that period, 929 had a first stroke, 22% of which were fatal within 28 days.
Of the 716 people who reported high stress, 59 had strokes, 18 of which were fatal.
Dr Thomas Truelsen, who led the research, said: "Lay people often mention stress as one of the most important risk factors for stroke, often before well-established stroke risk factors such as hypertension and smoking."
But he added: "The scientific literature is inconclusive. Although stress is often mentioned, there is little agreement on what it actually means or how it should be measured."
He said the high stress group could have had more severe strokes, a more complicated rehabilitation period, or some unknown biological mechanism may be important.
"Both the person feeling stressed and the physician being consulted should try not only to discuss stress but also stroke risk factors and what can be done to reduce them," he said.
Eoin Redahan of the UK Stroke Association said: "Stress is a very complicated issue and many people assume that it is a direct cause of stroke.
"This research sheds more light on the subject and raises the interesting question around whether stressed people are unhealthy in their lifestyle and hence increasing their risk of stroke because they are stressed.
"The overall message we would give is to try to keep stress down, a varied diet, get some exercise and check your blood pressure."
The research is published in Stroke: Journal of the American Heart Association.