Association of Emotional Stress and Adaptive Behavior with Stroke Risk: A Mendelian Randomization Study

Although emotional stress and adaptive behavior are known to influence cardiovascular health, direct evidence linking them to stroke remains limited. This study aims to clarify the associations between emotional stress, adaptive behaviors, and the risk of stroke. We conducted a two-sample Mendelian randomization analysis using data from the UK Biobank, the European Bioinformatics Institute, the Integrative Epidemiology Unit, and the FinnGen project. Indirect effects were estimated using the product of coefficients method. Low satisfaction with family relationships was associated with increased risks of all stroke and ischemic stroke. Mood swings were linked to higher risks of all stroke, ischemic stroke, and large-artery stroke, while feelings of tension were associated with large-artery stroke and small vessel stroke. Interestingly, nervousness was inversely associated with intracerebral hemorrhage risk. Participation in group leisure activities was associated with reduced risks of all stroke, ischemic stroke, and small vessel stroke. In contrast, several adaptive behaviors were linked to increased stroke risk, including vigorous physical activity (all stroke), summer outdoor activities (all stroke and ischemic stroke), winter outdoor activities (all stroke), and prolonged television watching (all stroke, ischemic stroke, and large-artery stroke). Mediation analyses suggested that hypertension, type 2 diabetes, atherosclerotic heart disease, and chronic ischemic heart disease may partially mediate these associations. The study provides genetic evidence supporting a potential causal relationship between emotional stress, adaptive behaviors, and stroke subtypes. Individuals can easily modify adaptive behaviors and manage emotional stress in their daily routines. Understanding these associations may inform future strategies for stroke prevention; however, due to limitations inherent in the current study design, our findings require further validation in large-scale prospective cohort studies.