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
Department of Neurology and Rehabilitation Medicine University of Cincinnati College of Medicine Cincinnati OH USA.
Department of Neurology The University of Chicago IL USA.
J Am Heart Assoc. 2025 Mar 18;14(6):e024457. doi: 10.1161/JAHA.121.024457. Epub 2025 Mar 7.
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.
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.
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.
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.
URL: clinicaltrials.gov; Unique Identifier: NCT01202864.
脑出血（ICH）的30天死亡率为40%至50%，且致残负担较重。既往研究发现，心理社会应激源与高血压、缺血性卒中相关，并且在基线应激方面存在重要的种族/民族差异。我们试图确定在控制重要风险因素后，应激（包括不同亚型）是否可预测脑出血风险；其效应是否由高血压介导；以及在应激相关脑出血方面是否存在重要的种族/民族差异。
使用来自ERICH（脑出血的种族/民族差异）研究的数据，这是一项针对白人、黑人和西班牙裔患者的脑出血前瞻性、多中心、病例对照研究。对照组按性别和种族或民族1:1匹配。参与者在脑出血前一周对4种应激亚型（经济、健康、情绪健康和家庭）进行0至10分的评分，0分表示无应激，10分表示应激程度最高。进行单变量和多变量逻辑回归以评估每种应激类型作为脑出血风险因素的情况，并进行中介分析以确定高血压是否介导了应激与脑出血之间的关联。
共有2964例病例/对照匹配（41.4%为女性，33.7%为黑人，32.7%为西班牙裔）。每种应激亚型水平的升高均增加了脑出血的可能性：经济、健康、情绪健康、家庭和总应激。经济应激与非叶性脑出血相关，且对黑人和西班牙裔患者的影响尤为严重。发现高血压介导了健康、情绪健康和家庭应激对脑出血风险的影响。
在控制高血压后，心理社会应激仍是脑出血的一个风险因素。这种关联背后的新机制值得进一步研究，并为减轻脑出血风险提供了一个新靶点。
网址：clinicaltrials.gov；唯一标识符：NCT01202864。
