Anxiety Disorders and Posttraumatic Stress Disorder Linked to Higher Risk for First-Ever Stroke

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Can Stress Cause a Stroke? Causes, Types, and Symptoms

by MJ Lambiase · 2013 · Cited by 163 — Higher anxiety symptom levels were associated prospectively with increased risk for incident stroke independent of other risk factors, including depression.

 post stroke anxiety(20% chance), and posttraumatic stress disorder(23% chance)

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Anxiety Disorders and Posttraumatic Stress Disorder Linked to Higher Risk for First-Ever Stroke

TOPLINE

In a meta-analysis of more than 11 million participants, anxiety disorders and posttraumatic stress disorder (PTSD) were associated with an increased risk for first-ever stroke, particularly ischaemic stroke. PTSD conferred the greatest risk (50%), followed by anxiety disorders (29%).

METHODOLOGY

• Investigators performed a systematic review and meta-analysis including 23 cohort studies with 11,181,338 participants (weighted mean age, 33.7 years; approximately 61% men) from Europe, North America, and East Asia. The median follow-up duration was 2-27 years.
• Researchers examined associations between anxiety disorders, obsessive-compulsive disorder (OCD), and PTSD and the risk for first-ever stroke; 16 of the 23 studies used clinically confirmed diagnoses based on diagnostic codes.
• In the remaining seven studies, the exposure was defined using validated self-reported symptom-based screening measures with established cutoff thresholds rather than formal clinical diagnoses.
• First-ever stroke was the primary outcome, categorised by type (ischaemic, haemorrhagic, or unspecified) and confirmed via a combination of clinical evaluation, imaging findings, discharge documentation, health system administrative records, or population-based registries.
• The analyses were stratified by exposure definition (clinical diagnosis vs self-reported symptom-based measures), stroke type, sex, and geographic region.

TAKEAWAY

• Clinically diagnosed anxiety disorders were associated with an increased risk for stroke (hazard ratio [HR], 1.29; P < .0001).
• PTSD was associated with the greatest risk for stroke among the exposures studied (HR, 1.50; P < .00001). Anxiety and related disorders combined were linked to an increased risk for first-ever stroke (HR, 1.38; P < .00001). OCD was associated with an increased risk for ischaemic stroke (HR, 1.26; 95% CI, 1.17-1.36) but not haemorrhagic stroke, although the finding was based on a single study.
• Self-reported symptom-based measures were also linked to an increased risk for stroke overall (HR, 1.39; P = .0002), an association driven mainly by probable PTSD (HR, 1.48; P = .0002); self-reported anxiety symptoms alone were not significantly associated with the risk for stroke.
• Analyses by stroke type showed an increased risk for ischaemic stroke (HR, 1.34; P = .0006); however, no significant association was observed for haemorrhagic stroke.

IN PRACTICE

"Findings suggest that these disorders may represent potential markers of vascular risk, particularly for ischaemic stroke," the authors wrote.

SOURCE

The study was led by Nafiz Imtiaz, Royal Holloway, University of London, London, England. It was published online on September 21, 2026, in the Journal of Affective Disorders.