A stressful job may be an independent risk factor for stroke onset. According to a Meta-analysis of 14 European cohort studies, sometimes unavoidable work-derived stress, defined as less time at one’s disposal in a work situation, is associated with an increased risk of ischemic stroke. Dr. Fransson said she was surprised to see the correlation in the Meta-analysis, writing in an email exchange with MedPage Today, ” Because many factors influence stroke risk, we did not expect to see any significant correlation between work strain and stroke. However, we did observe an increased risk of ischemic stroke in work-stressed individuals. This is consistent with data from our previous collaborative study, which noted that work stress was associated with an increased risk of developing coronary heart disease.” In this study, Dr. Fransson and colleagues examined the same increased risk of developing coronary heart disease in work-stressed compared with work-unstressed subjects (HR 1.23, 95% CI 1.10-1.37). The newly published analysis was performed using data from 14 prospective cohort studies conducted in Europe between 1985 and 2008 in which job stress was assessed by a job demand control questionnaire. Socioeconomic status was used as a surrogate marker for stroke risk, and recognized stroke risk factors in the data, such as diabetes, hypertension, smoking and alcohol consumption, were identified as stroke risk factors in some but not in all studies. Follow-up was from the time after the work stress assessment to the first stroke, death, or a mean of more than 9 years. 196,380 participants (mean age 42.4 years, 53% female) with no history of stroke and complete information on age, sex, socioeconomic status, work stress, and stroke events prior to the study assessment were included in the Meta-analysis. Participants in the cohort study reported work stress ranging from 13% to 22% and lasting 1.81 million person-years (mean follow-up 9.2 years), with 2,023 stroke events (1,049 ischemic strokes and 476 hemorrhagic strokes) recorded. After adjustment for age and sex, the hazard ratio was statistically insignificantly different between the work-stressed and work-unstressed groups (1.09, 95% CI, 0.94-1.26), and heterogeneity between study groups was estimated to be extremely low (I2 = 21.6%, P = 0.22),” according to the researchers. When further adjusted for socioeconomic status and further assessed for risk of various stroke subtypes, work stress increased the risk of ischemic stroke by 18% (HR 1.18, 95% CI 1.00-1.39) and not hemorrhagic stroke (HR 0.95, 95% CI 0.72-1.27). Despite the large sample size of the Meta-analysis, the number of ischemic and hemorrhagic stroke events in the study population was relatively small and the diagnosis was not always confirmed by brain imaging. Despite these potential study limitations, Fransson noted a significant correlation between ischemic stroke and work stress, but noted that large, interventional studies will be needed to demonstrate a causal relationship. ”It is important to recognize that stroke is a multifactorial disease, meaning that genetic, biological and lifestyle factors may play an important role and that stress may be a factor to consider.” She added that, like receiving advice on reducing stroke risk, avoiding prolonged mental stress may also be good to try.