Stress may affect risk factors like high blood
pressure, a result of habits such as smoking, drinking
Stress is
almost always seen in a bad light and the common assumption is that highly
stressed and overworked people have a higher risk of getting a stroke.
So, when
Finance Minister Heng Swee Keat collapsed during a Cabinet meeting nearly two
weeks ago, some were convinced that stress was definitely part of the equation.
He had
suffered a sudden stroke due to an aneurysm - a localised weakening of a blood
vessel - and needed surgery to relieve pressure in his brain due to the
bleeding.
Law and
Home Affairs Minister K. Shanmugam wrote on Facebook that he had been working
closely with Mr Heng and could see that he was very tired. "I have been
telling him that he was overworking so much that it will affect his health."
Stress
and working long hours are indeed associated with stroke, but they are not the
direct cause of one. Stress could, however, affect the risk factors for stroke,
such as high blood pressure. Habits such as smoking, drinking and overeating
can cause high blood pressure.
A stroke
occurs when there is bleeding or a blockage in a blood vessel caused by a clot.
Over the years, numerous studies have attempted to draw a link - though that
does not prove cause and effect - between stress and stroke.
The
latest meta-analysis - published last year in Neurology, the medical journal of
the American Academy of Neurology - combined six studies of 130,000 patients
and found that high-stress jobs were associated with increased risk of stroke.
Another
meta-analysis of 25 studies published in The Lancet medical journal found that
the longer the working week, the higher the risk of stroke. For instance, those
who worked more than 55 hours a week had a 33 per cent increased risk of stroke
compared with those who worked 35 to 40 hours a week.
The
study's authors suggest that unhealthy behaviour such as physical inactivity,
sitting for prolonged periods and the triggering of the stress response might
be behind the increased risk. They concluded that more attention should be
given to the management of vascular risk factors such as diabetes, hypertension
and obesity in those who work long hours, so that their stroke risk may be
decreased.
"Epidemiological
studies have shown that high-stress jobs are associated with an increased risk
of cardiovascular disease, especially hypertension and coronary heart
disease," said Dr Vincent Ng, a consultant at the National Neuroscience
Institute's department of neurosurgery.
Dr David
Choy, a consultant at Raffles Neuroscience Centre, said the dangers of overwork
were noted in 1969, when a 29-year-old male worker in Japan died of a stroke.
They called it karoshi, or death by overwork.
How
exactly stress contributes could be in sleep deprivation, he said, as multiple
studies have shown strong links between sleep loss and the development of
hypertension and even diabetes.
But there
is no evidence to show that chronic work stress can be the direct cause of a
brain aneurysm rupturing and leading to subarachnoid haemorrhage, a type of
haemorrhagic stroke.
Most
aneurysms develop after the age of 40, and more women than men are vulnerable.
In most
cases, why they rupture is unknown, though smoking and high blood pressure
raise the risks of rupture, especially in young women, said Dr Ng Puay Yong, a
neurosurgeon at Mount Elizabeth Hospital.
Brain
aneurysms can rupture at rest or under momentary stress, such as during
vigorous exercise or anger.
"The
common feature of these triggers is that they induce a sudden and short
increase in blood pressure, which results in an aneurysm rupture," Dr Choy
said. "Stress can and often does cause a sudden rise in blood pressure. In
people with an undiagnosed aneurysm, this may potentially result in a
rupture."
When an
aneurysm ruptures, the sufferer will experience a "thunderclap headache",
a sudden, severe headache often described as the worst headache of one's life.
"If
there is no intervention, about 15 per cent of these patients die on the spot,
15 per cent die in the next 24 hours and 15 per cent in the next six
weeks," said Dr Ng.
They die
from the massive brain injury from the initial bleeding.
"Of
those who survive, about 66 per cent suffer some permanent neurological
deficit," said Dr Teo Kejia, an associate consultant at National
University Hospital's division of neurosurgery.
Psychological
stress, which can cause a temporary rise in blood pressure, may raise the risk
of high blood pressure, he said. This in turn raises the risk of haemorrhagic
strokes, including aneurysm-related strokes.
"We
blame stress for a lot of things, but there's no scientific study to prove the
link between stress and stroke," said Dr Ng. "We know only that
certain conditions - such as smoking - can increase the risk."
And
smoking is what some people do when they feel stressed. The problem with
linking stress to diseases is that it is difficult to quantify stress and
determine the extent of its impact, but it seems likely it has an adverse
impact on health.
"A
certain degree of stress may improve performance and engagement. However,
prolonged and excessive stress may lead to burnout," said Dr Ng. "The
symptoms of burnout include feelings of being overwhelmed and inability to meet
constant demands, demotivation, low productivity and lack of energy. It leads
to depression and anxiety."
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