Study Finds Higher Stroke Risk in Women Experiencing More Stress

A new study offers more evidence that chronic stress may drive up the risk of stroke in younger adults.

The report, published on March 5 in Neurology, specifically revealed a link between high stress levels and an increased chance of stroke among people ages 18 to 49—but only for women. The researchers didn’t find an association between stress and stroke risk in men.

Researchers have long known that stress taxes the cardiovascular system. More recently, they've discovered it could be a risk factor for stroke in younger adults, which has been on the rise. But the new study suggests stress may potentially have a greater impact on women’s heart health in particular.

“The findings highlight how prolonged psychological stress may contribute to vascular dysfunction, emphasizing the importance of stress management for stroke prevention,” Lauren Patrick, MD, an assistant professor of neurology and vascular neurologist at the University of California San Francisco, told Health.

The scientists wanted to better understand the link between stress and early-onset ischemic stroke, which is the most common type. It can occur when a blockage disrupts blood flow to the brain.

Previous research has suggested several risk factors for stroke in younger people, including “traditional” ones, such as high blood pressure and alcohol consumption, as well as “less well-documented” ones—like stress, the study authors explained.

To explore the stroke-stress connection further, the researchers recruited 426 people ages 18 to 49, all of whom had an ischemic stroke and about half of whom were women. The team also included another 426 individuals who never had a stroke but were the same age and sex as members of the first group.

All participants completed a questionnaire about how stressed out they were over one month, and the group who had a stroke answered additional questions about their stress levels leading up to the stroke.

The surveys revealed that those who had strokes experienced significantly higher levels of stress. Of the group that had a stroke, 46% reported moderate to high stress levels, compared to just 33% of those who didn’t have a stroke.

In women, those who had moderate stress had a 78% increased risk of stroke, and high stress was linked to a 6% greater risk of stroke. The researchers didn’t find an association between men’s stress levels and stroke risk.

Notably, the authors concluded that stroke and stress are linked, not that stress directly causes strokes. “Case-control studies like ours can only show a correlation between stress and higher risk of stroke, not causality,” study author Nicolas Martinez-Majander, MD, PhD, a neurologist and researcher at the Helsinki University Hospital in Finland, told Health.

Additionally, people’s stress levels were evaluated after they experienced a stroke, which may have contributed to recall bias.

“Still, the difference observed between women and men was considered significant,” Martinez-Majander said.

There are a few leading theories as to why stress might have this effect on the cardiovascular system. “Potential links between stress and stroke might include acute, repeated short-term spikes in blood pressure, stress-related heart arrhythmias, and chronic inflammation,” Martinez-Majander said.

On top of that, people who are stressed may be more likely to engage in other activities that can damage the heart and further elevate stroke risk, such as smoking, physical inactivity, poor diet, and substance use, he added.

So, while stress may not directly trigger stroke, Patrick said, “it contributes to a cascade of physiological changes that increase stroke risk.” As such, long-term exposure to stress could be a significant vascular risk factor, she added.

While this study didn’t find an association between stress and stroke risk for younger men, it’s worth noting that prior research has identified a link between stress and stroke in men generally.

So, why was the link so pronounced in women in this report? “It might be stronger in women, as they often report experiencing more chronic stress due to juggling multiple roles, such as work, family, and caregiving,” Martinez-Majander said.

Christina Mijalski, MD, a vascular neurologist with Stanford Medicine, agreed. “This is something we need to pay attention to as a society and offer additional support in terms of childcare and wellness resources, which have lagged,” she told Health.

Another possibility: Men may underreport their stress levels compared to women. In fact, research shows that women are more likely to report somatic mental health symptoms, such as stress, than their male counterparts, Mijalski said.

Martinez-Majander said he hopes the findings will encourage people to monitor their stress levels. While it may be impossible to eliminate all stress in life, it’s worth trying to manage it when you can, given that it does appear to be a potential risk factor for stroke, even in young people.

The first step is to monitor yourself for signs of stress. These include persistent anxiety, trouble sleeping, recurring headaches, high blood pressure, and feelings of burnout, Patrick said. You may also notice changes in your appetite, problems concentrating, stomach problems, or body pains, according to the CDC.

If you regularly experience any of these symptoms, it’s crucial to be aware of stroke warning signs. Watch for sudden numbness or weakness, difficulty speaking, trouble walking, dizziness, vision changes, or intense headaches. “Stress may amplify underlying risk factors, making early recognition of stroke symptoms critical for timely treatment,” Patrick said.

If you’re unsure how stress is affecting your health, check in with your primary care physician. They are a great place to start, said Mijalski, as they can identify physiological risk factors, like hypertension and diabetes, and help you make a game plan to manage psychosocial and mental health stressors.

When it comes to that, Patrick’s recommendations include prioritizing regular exercise—ideally, 150 minutes a week, per the CDC—and engaging in mindfulness practices. There are many options, including meditation, yoga, and body scans. Even little activities like going for a mindful walk or being present while preparing a meal can make a difference, research shows.

Perhaps the most important thing, according to Mijalski, is to recognize when stress becomes overwhelming or unmanageable and seek help.