Anxiety disorders, PTSD, and risk of first-ever stroke: A meta-analysis of 11 million participants.
Nafiz Imtiaz, Redoy Ranjan, Gie Ken-Dror et al.
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In 30 seconds
This meta-analysis pooled 23 longitudinal cohort studies involving 11,181,338 participants to assess whether anxiety disorders, obsessive-compulsive disorder (OCD), and PTSD were associated with first-ever stroke. Clinically diagnosed anxiety disorders were associated with higher stroke risk (HR 1.29, 95% CI 1.14-1.46), while PTSD showed a stronger association (HR 1.50, 95% CI 1.31-1.72). Associations were observed for ischaemic stroke, but not statistically significant for haemorrhagic stroke. The findings indicate associations, not causation; evidence specific to OCD was limited.
Key findings
- Clinically diagnosed anxiety disorders were associated with stroke risk: HR 1.29, 95% CI 1.14-1.46.
- PTSD showed a stronger association with stroke risk: HR 1.50, 95% CI 1.31-1.72.
- The association was significant for ischaemic stroke (HR 1.34, 95% CI 1.13-1.58), but not haemorrhagic stroke (HR 1.24, 95% CI 0.95-1.62).
- Associations persisted after adjustment for cardiovascular risk factors and depression; OCD evidence came from one study.
Why it matters
The findings identify anxiety disorders and PTSD as potential markers of elevated vascular risk, with the clearest association for ischaemic stroke. This may help inform understanding of the relationship between mental health and vascular outcomes. Because the evidence is observational and cannot establish causality, it does not show that these disorders directly cause stroke.
What to keep in mind
The evidence is based on longitudinal cohort studies and cannot establish causality. OCD-specific evidence was limited to one study.