Anxiety and PTSD Linked to Higher First-Ever Stroke Risk

TOPLINEIn a meta-analysis of more than 11 million participants, anxiety disorders and posttraumatic stress disorder (PTSD) were associated with an increased risk for first-ever stroke, particularly ischaemic stroke. PTSD conferred the greatest risk (50%), followed by anxiety disorders (29%).METHODOLOGYInvestigators performed a systematic review and meta-analysis including 23 cohort studies with 11,181,338 participants (weighted mean age, 33.7 years; approximately 61% men) from Europe, North America, and East Asia. The median follow-up duration was 2-27 years.Researchers examined associations between anxiety disorders, obsessive-compulsive disorder (OCD), and PTSD and the risk for first-ever stroke; 16 of the 23 studies used clinically confirmed diagnoses based on diagnostic codes.In the remaining seven studies, the exposure was defined using validated self-reported symptom-based screening measures with established cutoff thresholds rather than formal clinical diagnoses.First-ever stroke was the primary outcome, categorised by type (ischaemic, haemorrhagic, or unspecified) and confirmed via a combination of clinical evaluation, imaging findings, discharge documentation, health system administrative records, or population-based registries.The analyses were stratified by exposure definition (clinical diagnosis vs self-reported symptom-based measures), stroke type, sex, and geographic region.TAKEAWAYClinically diagnosed anxiety disorders were associated with an increased risk for stroke (hazard ratio [HR], 1.29; P < .0001).PTSD was associated with the greatest risk for stroke among the exposures studied (HR, 1.50; P < .00001). Anxiety and related disorders combined were linked to an increased risk for first-ever stroke (HR, 1.38; P < .00001). OCD was associated with an increased risk for ischaemic stroke (HR, 1.26; 95% CI, 1.17-1.36) but not haemorrhagic stroke, although the finding was based on a single study.Self-reported symptom-based measures were also linked to an increased risk for stroke overall (HR, 1.39; P = .0002), an association driven mainly by probable PTSD (HR, 1.48; P = .0002); self-reported anxiety symptoms alone were not significantly associated with the risk for stroke.Analyses by stroke type showed an increased risk for ischaemic stroke (HR, 1.34; P = .0006); however, no significant association was observed for haemorrhagic stroke.IN PRACTICE"Findings suggest that these disorders may represent potential markers of vascular risk, particularly for ischaemic stroke," the authors wrote.SOURCEThe study was led by Nafiz Imtiaz, Royal Holloway, University of London, London, England. It was published online on September 21, 2026, in the Journal of Affective Disorders.LIMITATIONSThe observational design could not establish causality, and residual confounding may remain despite adjustment for cardiovascular risk factors and depression. Substantial heterogeneity was observed across studies, likely reflecting differences in populations, exposure definitions, and follow-up durations. Evidence for OCD was limited to one study. The evidence base excluded studies from Africa, the Middle East, and Central and South Asia.DISCLOSURESThis study did not receive any specific funding. The authors reported having no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.