Psychological distress is strongly associated with myocardial infarction (MI) and stroke despite adjustments for confounders, according to the results of a population-based prospective study published in Circulation: Cardiovascular Quality and Outcomes. The positive association is dose-dependent and persistent across sex and age, suggesting a direct mechanism linking psychological distress and MI and stroke.
A total of 221,677 participants without prior stroke or MI were enrolled from the New South Wales 45 and Up Study. Researchers categorized baseline psychological distress using the Kessler Psychological Distress scale and identified MI and stroke through hospital admission and mortality records. They investigated the interaction between psychological distress and MI and stroke using sex and age-stratified adjusted and unadjusted hazard ratios. The study is limited by an 18% participation rate and the possibility that not all cardiovascular and cerebrovascular disease events were identified.
Of the participants, 16.2% had high and 7.3% had very high psychological distress at recruitment. During the follow-up period, there were 4573 MIs and 2421 strokes. The risk for MI and stroke increased with mounting levels of psychological distress. In men aged 45 to 79, high/very high vs low psychological distress was associated with a 30% increased risk for MI. In women, high/very high psychological distress was associated with an 18% increased risk for MI. In all participants age 45 to 79, high/very high psychological distress was associated with a 24% and 44% increased stroke risk, respectively, and showed no evidence of interaction with age or sex.
Further research will determine the underlying mechanisms and causality. Regardless of causation, researchers wrote that “the growing evidence supports the need for renewed effort: to encourage people with symptoms of psychological distress to seek medical help; for more active screening of, and better treatment for, psychological distress (and diagnosed common mental disorders); and to encourage screening for traditional cardiovascular risk factors in people with symptoms of psychological distress or diagnosed common mental disorders.”
Jackson CA, Sudlow CLM, Mishra GD. Psychological distress and risk of myocardial infarction and stroke in the 45 and up study: a prospective cohort study. Circ Cardiovasc Qual Outcomes. 2018;11(9).