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PTSD Increases Risk for Stroke in Younger Years

Every year in the U.S., approximately 795,000 people have a stroke and 140,000 die as a result, making strokes not only a leading cause of death but also a common cause of serious, long-term disability.

Most often, strokes occur in those over the age of 65, but they can strike younger adults as well. In 2009, 34% of those hospitalized due to a stroke where under 65 years old, serving as a reminder that this condition may occur at any age.1

In fact, the American Heart Association says that 10% to 14% of ischemic strokes occur in people aged just 18 to 45 years old, and while strokes have generally been declining in older adults during the past decade, the rate among young adults has markedly increased.2 Researchers believe that psychological factors, including post-traumatic stress disorder (PTSD), may be an important risk factor in cases of early-onset stroke.

PTSD Increases Risk of Early-Onset Stroke

Using a cohort of 987, 855 young and middle-aged veterans, researchers assessed the incidence of transient ischemic attack (TIA) and ischemic stroke. The most common type of stroke, accounting for about 80% of cases — ischemic stroke — is caused by a blockage in a blood vessel in the brain or neck.3

A TIA, or mini stroke, is caused by a temporary blockage in your cerebral blood vessels. The symptoms are similar to those of a stroke, but they're typically milder and shorter in duration. Over the study’s 13-year duration, 28.6% of the sample were diagnosed with PTSD, and an association between the psychological condition and TIA and ischemic stroke emerged.

PTSD was significantly associated with early incident TIA and ischemic stroke. Participants with PTSD were 61% more likely to have TIA and 36% more likely to have ischemic stroke than veterans without PTSD.4 PTSD had a stronger effect on risk of ischemic stroke in men than women, and the associations remained even after accounting for other established stroke risk factors or coexisting psychiatric disorders.

Previous research has linked PTSD to cerebrovascular disease in older adults, and a 2015 study linked PTSD with an increased risk of developing any stroke and ischemic stroke.5 The INTERHEART study also found that psychological stressors, including general stress, adverse life events and financial stress, also predicted risk of stroke, with the effect being stronger in younger adults compared to older adults.6

PTSD is linked with many stroke risk factors, including high blood pressure and diabetes, which is one reason why it may increase the risk. The authors of the featured study, published in Stroke, also hinted at the potential mechanisms linking PTSD to stroke in younger adults, noting:7

“Although the mechanisms linking PTSD to incident stroke are not fully understood, multiple pathways are possible. Prolonged exposure to intense psychological stress is associated [with] chronic inflammation, endothelial dysfunction, platelet activation and aggregation, and autonomic dysregulation, all of which could conceivably contribute to atherothrombotic manifestations.

Stress is also associated with a greater likelihood of smoking, physical inactivity, poor diet, and substance abuse, which may increase risk for early stroke. However, we controlled for most of these lifestyle behaviors, and the findings were largely maintained.

Other relevant health factors such as sleep disturbance, migraine, and periodontal disease have been shown to increase risk of stroke in the young. Evaluating the complex interplay between these health factors, PTSD and stroke in young adults is an important area for further research.”

What Are Other Stroke Risk Factors?

There are a number of risk factors for stroke, many of them physical in nature. High blood pressure is the greatest one, increasing risk of stroke by two to fourfold.8 Other health conditions, including heart disease, diabetes, atherosclerosis and obesity, also increase the risk, as do smoking cigarettes and physical inactivity.

Among younger adults, in particular, men have a higher risk of stroke than women, and African-Americans and Hispanic Americans are about two times more likely to have a stroke than Caucasians.9

Further, according to Dr. Lee H. Schwamm, director of the comprehensive stroke center at Massachusetts General Hospital, and Dr. Lawrence R. Wechsler, chairman of the department of neurology at the University of Pittsburgh School of Medicine, the risk factors for stroke among patients under the age of 50 differ from those in older patients, and include the following:10

Arterial dissection causing a blood clot — Causes of arterial dissection, which is when the lining of an artery tears, can occur during sudden neck movements, including sports injuries to the neck and jolting that can occur when riding a roller coaster

Hole in the heart (patent foramen ovale) — An estimated 1 in 4 people has this condition, which raises your odds of a stroke, as it can allow a blood clot to cross through your heart and into your brain

Blood clots

Heart defects or disturbed heart rhythm

Narrowing of the arteries caused by stimulants or drugs, causing a sudden lack of oxygen to your brain

Aneurism or arteriovenous malformation

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