Self-perceived stress tied to higher stroke risk in young women

A recent study found that self-perceived stress may increase the risk of early-onset cryptogenic ischaemic stroke (CIS) in young adults, particularly women.

“This analysis adds to previous knowledge from earlier studies of associations between psychosocial stress and stroke by demonstrating that self-perceived stress was strongly correlated with IS, extending the evidence to early-onset CIS and using a validated stress measure, the Perceived Stress Scale (PSS),” said the researchers.

Researchers conducted a multicentre case-control study involving 426 patients (mean age 41 years, 47.7 percent female) with CIS and matched them with 426 stroke-free controls by age and sex. PSS scores were used to determine stress levels, categorized as low (0–13 points), moderate (14–26 points), and high (27–40 points). [Neurology 2025;104:e213369]

In the entire cohort, moderate or high levels of self-perceived stress were associated with a significantly higher risk of developing CIS than a low level of stress (odd ratios [ORs], 1.71; p<0.001 and 2.90; p=0.024, respectively).

Results also showed that patients with CIS were significantly more likely to be moderately or highly stressed than their stroke-free counterparts (46.2 percent vs 33.3 percent; p<0.001 and 4.2 percent vs 1.6 percent; p=0.043, respectively).

When stratified by sex, women with a moderate level of stress had a 78-percent increased risk of CIS (OR, 1.78; p=0.026), while those with a high level of stress had a 6-percent increased risk (OR, 1.02; p=0.005) after adjusting for potential confounders.

The researchers said “one potential explanation for the higher self-perceived stress in women could be related to societal and psychological factors, where women often report experiencing more chronic stress due to juggling multiple roles, such as work, family, and caregiving.”

On the other hand, no significant association was observed between stress levels and CSI risk in men (ORs, 1.06; p=0.850 [moderate] and 1.02; p=0.499 [high]).

“Men’s lower stress scores may reflect societal conditioning to under-report stress, introducing potential bias in self-perceived stress measurements,” noted the researchers.

When stratified by age, higher levels of stress were significantly associated with CIS only among younger patients aged 18–39 years (OR, 1.06; p=0.042).

“Overall, our multicentre case-control study found that higher self-perceived psychosocial stress appeared to be associated with early-onset CIS, independent of traditional stroke risk factors,” said the researchers. “Subgroup analyses reinforced this link in women, although it was not observed in men.

“Further research is needed to delve deeper into the mechanisms that heighten the risk of early-onset CIS in individuals experiencing self-perceived stress, particularly focusing on the impact on the coagulation system and related pathways,” noted the researchers.

“Given the potential importance of CIS in the context of early-onset strokes, understanding the role of self-perceived stress in this population may be crucial to developing more effective prevention strategies,” they added.