Journal of the American Heart Association · 2025
Psychosocial Stress and Risk for Intracerebral Hemorrhage in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) Study.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Behymer Tyler P, Sekar Padmini, Demel Stacie L, Aziz Yasmin N, Coleman Elisheva R, Williamson Brady J, Stanton Robert J, Sawyer Russell P, Turner Ashby C, Vagal Vaibhav S, Osborne Jennifer, Gilkerson Lee A, Comeau Mary E, Flaherty Matthew L, Langefeld Carl D, Woo Daniel
Аннотация
BACKGROUND: Intracerebral hemorrhage (ICH) carries a 30-day mortality rate of 40% to 50% and a high burden of disability. Prior studies found that psychosocial stressors are associated with hypertension, ischemic stroke, and important racial/ethnic differences in baseline stress exist. We sought to determine whether stress, including distinct subtypes, predicts risk of ICH after controlling for important risk factors; whether its effect is mediated by hypertension; and whether important racial/ethnic differences in stress-associated ICH exist.
METHODS: Data from the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study, a prospective, multicenter, case-control study of ICH among White, Black, and Hispanic patients were used. Controls matched 1:1 by sex and race or ethnicity. Participants rated 4 stress subtypes (financial, health, emotional well-being, and family) on a 0 to 10 scale for the week before ICH, with 0 signifying no stress and 10 highest stress. Univariate and multivariable logistic regressions to assess each stress type as a risk factor for ICH and mediation analyses to determine whether hypertension mediated the association between stress and ICH were performed.
RESULTS: There were 2964 case/control matches (41.4% female, 33.7% Black, and 32.7% Hispanic). Higher levels of each stress subtype increased probability of ICH: financial, health, emotional well-being, family, and total stress. Financial stress was associated with nonlobar ICH and disproportionately affected Black and Hispanic patients. Hypertension was found to mediate the ICH risk effects of health, emotional well-being, and family stress.
CONCLUSIONS: Psychosocial stress remains a risk factor for ICH after controlling for hypertension. Novel mechanisms underlying this association warrant further study and offer a new target for ICH risk mitigation.
REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT01202864.
METHODS: Data from the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study, a prospective, multicenter, case-control study of ICH among White, Black, and Hispanic patients were used. Controls matched 1:1 by sex and race or ethnicity. Participants rated 4 stress subtypes (financial, health, emotional well-being, and family) on a 0 to 10 scale for the week before ICH, with 0 signifying no stress and 10 highest stress. Univariate and multivariable logistic regressions to assess each stress type as a risk factor for ICH and mediation analyses to determine whether hypertension mediated the association between stress and ICH were performed.
RESULTS: There were 2964 case/control matches (41.4% female, 33.7% Black, and 32.7% Hispanic). Higher levels of each stress subtype increased probability of ICH: financial, health, emotional well-being, family, and total stress. Financial stress was associated with nonlobar ICH and disproportionately affected Black and Hispanic patients. Hypertension was found to mediate the ICH risk effects of health, emotional well-being, and family stress.
CONCLUSIONS: Psychosocial stress remains a risk factor for ICH after controlling for hypertension. Novel mechanisms underlying this association warrant further study and offer a new target for ICH risk mitigation.
REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT01202864.