New findings indicate that the risk of developing ischemic strokes is increased in people with obsessive-compulsive disorder (OCD), with older adults prone to the highest risk of ischemic stroke, yet the mechanistic association between OCD and stroke risk remains unclear.
Obsessive-Compulsive Disorder (OCD). Image Credit: StepanPopov/Shutterstock.com
The relationship between cerebrovascular disease and obsessive-compulsive disorder (OCD)
OCD is a common and sometimes debilitating mental health condition, driving compulsive behaviors, which can interfere with a person's daily activities and social interactions. Although often missed or frequently undertreated, the World Health Organization (WHO) places OCD in the ten most disabling conditions worldwide, with a lifetime prevalence of 1% to 3%.
Clinal research has shown patients with OCD tend to also suffer from stroke-related metabolic disorders, such as obesity and diabetes. These factors can contribute to increasing the risk of developing a stroke, which is a medical emergency occurring due to interrupted blood and oxygen flow to the brain. The most common stroke is due to a blood clot interrupting flow (ischemic stroke), with less common being due to a burst blood vessel that causes bleeding in the brain (hemorrhagic stroke).
Although mounting evidence indicates there is an association between OCD and stroke risk, particularly as stroke patients sometimes develop OCD post-stroke, the reverse may also be true. That is, new research has examined whether OCD itself increases stroke risk in a study published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.
OCD increases the risk for ischemic stroke more than 3 times particularly among older adults
Using health records from 2001-2010 from the Taiwan National Health Insurance Research Database, researchers compared stroke risk between 28,064 adults with OCD and 28,064 adults who did not have OCD. The average age at diagnosis was 37 years old, with equal representation of men and women, with data for patients lasting up to 11 years.
Analyzing the collected data showed that even after controlling for factors known to increase stroke risk including obesity, heart disease, smoking, high blood pressure, and high cholesterol, OCD remained an independent risk factor for ischemic stroke. Adults with OCD had more than 3 times the chance to develop ischemic stroke compared to adults without OCD, with particularly significant differences in older adults, as the greatest risk was among adults aged 60 and older.
However, no differences were found when considering hemorrhagic strokes (burst blood vessels), and medications to treat OCD were not associated with an increased risk of stroke.
The results of our study should encourage people with OCD to maintain a healthy lifestyle, such as quitting or not smoking, getting regular physical activity and managing a healthy weight to avoid stroke-related risk factors,"
Ya-Mei Bai, M.D., Ph.D., Professor, Department of Psychiatry, Taipei Veterans General Hospital
Understanding why, how, and when the risk to develop strokes increases
Worldwide, stroke is the second-leading cause of death after heart disease. Cerebrovascular diseases often present complex cases, and this study was the first to consider how OCD and strokes may be associated on a longer time scale. However, limitations in the data are important to consider in future research.
For instance, only stroke among patients who sought health care were included in the data, so some cases may have been missed. Moreover, information on disease severity and outcome was not included along with family medical history or environmental influences, which can further affect both the extent of OCD and severity of strokes. Finally, this study was primarily observational, and although it showed an association between OCD and later stroke; it does not prove cause or effect.
"For decades, studies have found a relationship between stroke first and OCD later," Bai said.
Our findings remind clinicians to closely monitor blood pressure and lipid proles, which are known to be related to stroke in patients with OCD. More research is needed to understand how the mental processes connected to OCD may increase the risk of ischemic stroke".
- Stroke. 2021;52:00–00. DOI: 10.1161/STROKEAHA.120.032995