The prognostic significance of stress-phenotyping for stroke incidence : the Malmö Diet and Cancer Study
(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)
- author
- Holm, H
LU
; Jujic, A
LU
; Nilsson, P M LU ; Magnusson, M LU
and Malan, L
- organization
- publishing date
- 2025
- 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}}, }