Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

The prognostic significance of stress-phenotyping for stroke incidence : the Malmö Diet and Cancer Study

Holm, H LU ; Jujic, A LU orcid ; Nilsson, P M LU ; Magnusson, M LU orcid and Malan, L (2025) In Stress 28(1).
Abstract

BACKGROUND: Self-reported mental stress is not consistently recognized as a risk factor for stroke. This prompted development of a novel algorithm for stress-phenotype indices to quantify chronic stress prevalence in relation to a modified stroke risk score in a South African cohort. The algorithm is based on biomarkers adrenocorticotrophic hormone, high-density lipoprotein cholesterol, high-sensitive cardiac-troponin-T, and diastolic blood pressure which exemplifies the stress-ischemic-phenotype index. Further modification of the stroke risk score to accommodate alcohol misuse established the stress-diabetes-phenotype index. Whether positive stress-phenotype individuals will demonstrate a higher incidence of stroke in an independent... (More)

BACKGROUND: Self-reported mental stress is not consistently recognized as a risk factor for stroke. This prompted development of a novel algorithm for stress-phenotype indices to quantify chronic stress prevalence in relation to a modified stroke risk score in a South African cohort. The algorithm is based on biomarkers adrenocorticotrophic hormone, high-density lipoprotein cholesterol, high-sensitive cardiac-troponin-T, and diastolic blood pressure which exemplifies the stress-ischemic-phenotype index. Further modification of the stroke risk score to accommodate alcohol misuse established the stress-diabetes-phenotype index. Whether positive stress-phenotype individuals will demonstrate a higher incidence of stroke in an independent Swedish cohort was unknown and investigated.

METHODS: Stress-phenotyping was done at baseline for 50 participants with incident stroke and 100 age-, and sex matched controls (aged 76 ± 5 years) from 2,924 individuals in southern Sweden. The mean time from inclusion to first stroke event was 5 ± 3 years. Stress-phenotyping comparisons and stroke incidence risk were determined.

RESULTS: A positive stress-ischemic-phenotype reflected higher incident stroke (72% vs. 28%, p = 0.019) and mortality rates (41% vs. 23%, p = 0.019). Whereas a positive stress-diabetes-phenotype reflected a higher incident stroke rate (80% vs. 20%, p = 0.008) but similar mortality rate (38% vs. 25%, p = 0.146). Both the positive stress-ischemic (OR: 2.9, 95% CI: 1.3-6.5, p = 0.011) and stress-diabetes-phenotypes (OR: 3.7, 95% CI: 1.5-8.9, p = 0.004) showed large effect size associations with incident stroke independent of cardiovascular risk confounders.

CONCLUSION: Positive stress-phenotype indices demonstrated a higher incidence of stroke. Ultimately the Malan stress-phenotype algorithms developed in South Africa could confirm incident stroke in an independent Swedish cohort. Stress-phenotyping could thus be useful in clinical routine practice in order to detect individuals at higher stroke risk.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Male, Female, Sweden/epidemiology, Stroke/epidemiology, Stress, Psychological/epidemiology, Aged, Incidence, Phenotype, Prognosis, Risk Factors, Biomarkers/blood, Aged, 80 and over
in
Stress
volume
28
issue
1
article number
2443980
publisher
Taylor & Francis
external identifiers
  • pmid:39731532
  • scopus:85213836870
ISSN
1607-8888
DOI
10.1080/10253890.2024.2443980
language
English
LU publication?
yes
id
ffacf0fb-211c-45ed-9d84-f48667c025a7
date added to LUP
2025-01-03 10:19:26
date last changed
2025-06-11 16:14:57
@article{ffacf0fb-211c-45ed-9d84-f48667c025a7,
  abstract     = {{<p>BACKGROUND: Self-reported mental stress is not consistently recognized as a risk factor for stroke. This prompted development of a novel algorithm for stress-phenotype indices to quantify chronic stress prevalence in relation to a modified stroke risk score in a South African cohort. The algorithm is based on biomarkers adrenocorticotrophic hormone, high-density lipoprotein cholesterol, high-sensitive cardiac-troponin-T, and diastolic blood pressure which exemplifies the stress-ischemic-phenotype index. Further modification of the stroke risk score to accommodate alcohol misuse established the stress-diabetes-phenotype index. Whether positive stress-phenotype individuals will demonstrate a higher incidence of stroke in an independent Swedish cohort was unknown and investigated.</p><p>METHODS: Stress-phenotyping was done at baseline for 50 participants with incident stroke and 100 age-, and sex matched controls (aged 76 ± 5 years) from 2,924 individuals in southern Sweden. The mean time from inclusion to first stroke event was 5 ± 3 years. Stress-phenotyping comparisons and stroke incidence risk were determined.</p><p>RESULTS: A positive stress-ischemic-phenotype reflected higher incident stroke (72% vs. 28%, p = 0.019) and mortality rates (41% vs. 23%, p = 0.019). Whereas a positive stress-diabetes-phenotype reflected a higher incident stroke rate (80% vs. 20%, p = 0.008) but similar mortality rate (38% vs. 25%, p = 0.146). Both the positive stress-ischemic (OR: 2.9, 95% CI: 1.3-6.5, p = 0.011) and stress-diabetes-phenotypes (OR: 3.7, 95% CI: 1.5-8.9, p = 0.004) showed large effect size associations with incident stroke independent of cardiovascular risk confounders.</p><p>CONCLUSION: Positive stress-phenotype indices demonstrated a higher incidence of stroke. Ultimately the Malan stress-phenotype algorithms developed in South Africa could confirm incident stroke in an independent Swedish cohort. Stress-phenotyping could thus be useful in clinical routine practice in order to detect individuals at higher stroke risk.</p>}},
  author       = {{Holm, H and Jujic, A and Nilsson, P M and Magnusson, M and Malan, L}},
  issn         = {{1607-8888}},
  keywords     = {{Humans; Male; Female; Sweden/epidemiology; Stroke/epidemiology; Stress, Psychological/epidemiology; Aged; Incidence; Phenotype; Prognosis; Risk Factors; Biomarkers/blood; Aged, 80 and over}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Taylor & Francis}},
  series       = {{Stress}},
  title        = {{The prognostic significance of stress-phenotyping for stroke incidence : the Malmö Diet and Cancer Study}},
  url          = {{http://dx.doi.org/10.1080/10253890.2024.2443980}},
  doi          = {{10.1080/10253890.2024.2443980}},
  volume       = {{28}},
  year         = {{2025}},
}