Published Online
on March 15, 2007

A more recent version of this article appeared on May 1, 2007

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Submitted on September 18, 2006
Revised on November 20, 2006
Accepted on December 11, 2006

Adaptation to Social Adversity Is Associated With Stroke Incidence. Evidence From the EPIC-Norfolk Prospective Cohort Study

Paul G. Surtees PhD^*; Nicholas W.J. Wainwright PhD; Robert L. Luben BSc; Nicholas J. Wareham MBBS, PhD; Sheila A. Bingham PhD; and Kay-Tee Khaw MBBChir

From the Strangeways Research Laboratory and University of Cambridge Department of Public Health and Primary Care (P.G.S., N.W.J.W., R.L.L.), Worts Causeway, Cambridge, UK; the Medical Research Council Epidemiology Unit (N.J.W.), Elsie Widdowson Laboratories, Cambridge, UK; the Medical Research Council Dunn Human Nutrition Unit (S.A.B.), Cambridge, UK; and the Clinical Gerontology Unit (K.-T.K.), University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK.

^* To whom correspondence should be addressed. E-mail: paul.surtees{at}srl.cam.ac.uk.

Background and Purpose--Laboratory-based studies have suggested that individual differences in cardiovascular reactivity and stress adaptive capacity are associated with stroke incidence. We test the hypothesis that sense of coherence (SOC), a marker of social stress adaptive capacity, is associated with incident stroke in a population-based prospective cohort study.

Methods--A total of 20 629 participants, aged 41 to 80 years, in the UK European Prospective Investigation into Cancer (EPIC)-Norfolk study, who had not previously experienced a stroke, completed assessments that included SOC and details of their experience of life events during adulthood. An index of adaptation was constructed from responses to questions concerning over 80 000 adverse life events.

Results--During 145 000 person-years of follow-up (mean 7.1 years), 452 participants experienced either a fatal or nonfatal stroke event. A strong (as opposed to a weak) SOC was associated with a reduced rate of stroke incidence (rate ratio 0.76; 95% CI, 0.60 to 0.96) after adjustment for age, sex, pre-existing myocardial infarction, diabetes, hypertension treatment, family history of stroke, cigarette smoking, systolic blood pressure, obesity, social class, education, hostility and depression. No sex difference in this association was observed. Measures of social adversity occurrence and impact were not associated with stroke incidence, whereas faster reported adaptation to adverse event exposure was associated with a reduced rate of stroke incidence (rate ratio 0.89; 95% CI, 0.81 to 0.98; per standard deviation change in adaptation score, adjusted for age and sex).

Conclusions--Stress adaptive capacity is a potentially important candidate risk factor for stroke.

Key words: epidemiology • follow-up studies • stress • stroke

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