PTSD Increases Risk for Stroke in Younger Years

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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

Medications and Hair Salons: Other Little-Known Stroke Risks

There are other somewhat surprising stroke risks worth mentioning, especially for younger or middle-age adults. Using antibiotics for an extended period of time during middle-age or later may increase the risk of cardiovascular disease, including heart attack and stroke, in women, for instance.11

Overall, among women in late adulthood who take antibiotics for two months or more, 6 in 1,000 would develop cardiovascular disease, compared to 3 per 1,000 for women who would not. Women in middle age (40 to 59 years) who used antibiotics for longer than two months also had a 28% increased risk of cardiovascular disease.

The women used antibiotics most often for respiratory infections, urinary tract infections and dental problems, although the results held true even after the reasons behind the usage were factored in. Antibiotics’ role in wiping out beneficial gut bacteria was highlighted as one likely reason for the increased heart risks.

“Antibiotic use is the most critical factor in altering the balance of microorganisms in the gut. Previous studies have shown a link between alterations in the microbiotic environment of the gut and inflammation and narrowing of the blood vessels, stroke and heart disease,” lead study author Dr. Lu Qi, director of the Tulane University Obesity Research Center in New Orleans, said.12

Vertebral artery dissection from hyperextension of the neck, otherwise known as beauty parlor stroke syndrome, can also occur at any age after having your hair washed in a salon. The act of extending your neck over the shampoo bowl is the likely culprit, although it’s unclear if the condition results solely from a kink in the neck or in combination with a certain head movement caused by the stylist.13

Put simply, when your neck is hyperextended over the edge of a shampoo bowl, the pressure and/or whiplash-like motions on your neck can lead to a tear in the vertebral artery, which supplies blood to your brain. It’s a rare event that can occur in a number of scenarios, not just at the beauty parlor.

In a conversation with The Atlantic, Dr. Richard Bernstein, medical director of the Comprehensive Stroke Center at Northwestern Memorial Hospital in Chicago, explained that the phenomenon can occur due to innocent stretching, sneezing or even getting out of bed wrong in the morning, noting, “It is so rare that it’s a waste of time to worry about it. It’s so unlikely, and there’s really nothing you can do to prevent it.”14

Can PTSD Be Treated?

Strokes can have a devastating impact on quality of life, especially when they occur in young people. Researchers noted in stroke, “Stroke has an especially devastating impact on young patients and their families, many of whom struggle to cope with long-term disability, depression, and economic loss during their most productive years.”15 Fortunately, PTSD can potentially be treated, helping to lower the risk of stroke and other associated health conditions.

It’s estimated that 8 million adults in the U.S have PTSD in any given year, while 7% to 8% of the population will struggle with the condition at some point in their lives.16 PTSD can cause flashbacks, nightmares, anxiety and sleep disturbances, along with intense emotions that severely affect quality of life. Antidepressants are often prescribed to treat PTSD, but natural treatments, like orange essential oil, also exist.

Mice exposed to orange essential oil were significantly less likely to exhibit fear-based freezing behavior. In fact, the oil-treated mice stopped freezing altogether and earlier than the mice receiving other types of treatment. Moreover, these mice experienced a significant decrease in the immune cells linked to the biochemical pathways associated with PTSD.17

Service dogs and animal-assisted therapy are other treatment options. In one study, psychologists noted an 82% reduction in symptoms among patients with PTSD who engaged in animal-assisted therapy.

“One particular case noted that interacting with the dog for as little as one week, enabled a patient to decrease the amount of anxiety and sleep medications by half,” researchers noted in the Journal of Evidence-Informed Social Work.18

The Emotional Freedom Techniques (EFT) can also be very effective in reducing symptoms of anxiety and depression by correcting the bioelectrical short-circuiting that causes your body's reactions. This technique is particularly powerful for treating anxiety and stress because it targets your amygdala and hippocampus, parts of your brain designed to help you decide if something is a legitimate threat.

In the video below, EFT practitioner Julie Schiffman demonstrates how to use EFT to address panic attacks and other anxiety disorders. For serious issues such as PTSD, you will be best served by seeking out a qualified health care professional trained in EFT to help guide you through the process.

Know the Symptoms of Stroke and Act FAST

In the event of a stroke, emergency medications can dissolve the clot that is blocking blood flow to your brain, but in order to be effective, you typically need to get help within three hours — and the sooner the better.19 Knowing the following symptoms of stroke and calling 911 immediately can therefore be the difference between life and long-lasting disability or death.

  • Sudden numbness or weakness of face, arm or leg, especially when occurring on one side of the body; face drooping, typically on just one side
  • Sudden confusion; trouble talking or understanding speech
  • Sudden trouble seeing in one or both eyes, or double vision
  • Sudden trouble walking, dizziness or loss of balance or coordination
  • Sudden severe headache with no known cause; nausea or vomiting

Even if the symptoms are brief and disappear, a mini stroke may have occurred, so get emergency help if you or a loved one experiences any of these symptoms. A helpful acronym to memorize is FAST:

F: Face drooping

A: Arm weakness

S: Speech impairment

T: Time to call 911!

While PTSD is likely to emerge as an important contributor to stroke, the vast majority of strokes are linked to modifiable lifestyle factors. I strongly encourage you to take control of your health to reduce your risk and learn about more stroke prevention strategies here.

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