Does Stress Cause Stroke?

We know too much stress is unhealthy — it can cause headaches, upset stomach, anxiety, trouble sleeping  and more. But could it also raise your risk of stroke? Ryan Sundermann, MD, with UnityPoint Health, breaks down what happens in the body during stress and during a stroke — and what that means for your risk.

Do I Have Too Much Stress?

Dr. Sundermann says many people ignore stress and don’t deal with it the way they should. Determining how much stress you have is difficult to measure because everyone has different tolerances to stress.

“One person’s stress is not the same as another’s. Some folks have a lot of stress just from dealing with kids and finances. Others might carry the stress of running a small business or an entire corporation. Then, there are jobs where people are faced with real world dangers, like firefighters and police officers, who may be able to tolerate more stressful situations. Regardless of your job, if you feel you’re under stress, you probably are,” Dr. Sundermann says.

If you’re still unsure, ask yourself these questions:

• Do friends or loved ones comment that you seem stressed?
• Are you at odds with coworkers and family members more than normal?
• Do you find less joy in things that normally make you happy?
• Do you find it difficult to fall or stay asleep compared to normal?
• Do you have a hard time getting out of bed, especially on days you know will be stressful?
• Do you resort to alcohol, drugs or tobacco to cope with stress?

What Happens in the Body During Stress?

Dr. Sundermann says during stress, the brain triggers a release of chemicals that do several things to prepare us for a threat. These chemicals are produced regardless of the type of stress: physical harm, fear, grief, daily stress from work and relationships, etc. Two chemicals the brain release are cortisol and adrenaline.

• Adrenaline: This hormone is also known as epinephrine and is a type of catecholamines. Adrenaline, and its similar chemicals, cause increased heart rate and increased blood pressure to pump blood to vital organs.
• Cortisol: It’s a hormone that forces our body to retain water and sodium that help to keep blood pressure up. It also has several mechanisms to store sugar, but also makes that sugar available for use, so our bodies have fuel. Evolutionarily, this process is great for preparing us to run from a dangerous animal, fight off an attacker or, in today’s world, deal with a big problem at work when we are tired from a long day.

On their own, occasional spikes in cortisol and adrenaline aren't dangerous — they're part of how your body responds to everyday demands. But when stress becomes chronic and cortisol stays elevated for too long, it can start to affect your health, including your risk factors for stroke.

What Happens in the Body During a Stroke?

There are two main types of stroke, those that block arteries and those that cause arteries to bleed.

• Hemorrhagic strokes are caused by bleeding in the brain. The most common cause is head trauma, but they can also result from a ruptured aneurysm — a weak spot in a vessel wall — with high blood pressure often a contributing factor. Vessels weakened by chronic, very high blood pressure can also be involved. When a vessel breaks, blood leaks into surrounding tissue and the brain doesn't get the oxygen and nutrients it needs.
• Ischemic strokes result from blocked arteries, which often occur from cholesterol buildup, called plaque.

“You can think of plaques like scabs on the inside of the vessel. As an example, if you have ever lifted up a scab on your arm, if you lift too far, you can cause it to bleed again because it’s not done healing underneath. Then, you’ve created a new injury. In the case of your arm, a new scab forms by forming a clot, which is great for helping the skin heal. Similarly, plaques on the inside of the vessel can be fragile when blood flows past, causing the plaque to lift.  But in your blood vessel, when a plaque lifts up and the body tries to heal it like it would a scab on your arm, it makes a clot where that plaque lifted up which blocks blood flow and can lead to an ischemic stroke,” Dr. Sundermann says.

Does Stress Cause a Stroke?

You may have heard the term “stroke out,” but does stress cause a stroke? Dr. Sundermann says the short answer is no, but the longer answer is possibly.

“If you are otherwise low risk, then intermittent episodes of high stress shouldn’t put you at any increased risk for stroke,” Dr. Sundermann says.

Low stroke risk includes:

• Blood pressure under control, with or without medication
• Don’t have a family history of vascular disease
• Eat a well-balanced diet
• Exercise regularly
• Low levels of bad cholesterol
• Normal weight/low body fat

"If you're at an increased risk because of your family history or other risk factors, such as tobacco use, peripheral artery disease or high blood pressure, then a very stressful event is going to increase cortisol and adrenaline, which can raise blood pressure and cause stress to vessels already at risk. The increased blood flow could also disrupt plaques that might be fragile," Dr. Sundermann says.

Dr. Sundermann says if you live in a chronic or persistent state of stress, there is some evidence of increased stroke risk. He notes, however, the connection is complicated and not fully understood. But, he says when you look at the basics of stress and stroke, it makes sense.

“When under constant stress, you have persistent high levels of cortisol and other stress hormones. This causes retention of salt, which increases blood pressure. Over time, that puts stress on blood vessels. Stress also causes an increase in blood sugar, which means the vessels can’t dilate or contract to better control blood flow. Increased cortisol also disrupts sleep cycles, which can make us more stressed and release more cortisol. Poor sleep means fatigue, and fatigue can cause us to gain weight for several reasons. Simply, when we are tired we are less likely to exercise and more likely to eat poorly,” Dr. Sundermann says.

He adds that anyone can be at risk of stroke for many reasons, not just stress. Sometimes, it’s just how you are made. However, if you are worried about your level of stress, talk to your doctor about ways to get it to a manageable level.

“Preventing stroke can be as simple as exercising regularly and managing stress. It's nothing you haven't heard your entire life. But, doing it is the hard part,” Dr. Sundermann says.