stroke risk

Influenza Vaccines Linked to Elevated Stroke Risk in Elderly: FDA Study

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Getting COVID-19 and influenza vaccines at the same time led to higher risk of stroke, researchers find.

Influenza Vaccines Linked to Elevated Stroke Risk in Elderly: FDA Study
A person receives an influenza vaccine in Chicago, Ill., in a file photograph.

Some people who received a COVID-19 vaccine were at higher risk of stroke but an analysis found that the risk was connected to influenza vaccination, U.S. Food and Drug Administration (FDA) researchers said in a new study.

The researchers, analyzing data from Medicare, detected an elevated stroke risk among the elderly following receipt of a bivalent COVID-19 vaccine made by Pfizer and Moderna and available from the fall of 2022 to the fall of 2023. There was an elevated risk of nonhemorrhagic stroke or transient ischemic attack in people 85 or older following Pfizer vaccination and people aged 65 to 74 following Moderna vaccination, the researchers found.

But the researchers then looked at which people received an influenza shot at the same time as a COVID-19 shot and saw that the elevated risk only persisted among people who received the vaccines concomitantly.

“This finding suggests that the observed association between vaccination and stroke in the concomitant subgroup was likely driven by a high-dose or adjuvanted influenza vaccination,” Steven Anderson, director of the Office of Biostatistics and Epidemiology at the FDA, and the other researchers wrote.

High-dose influenza vaccines are primarily for the elderly, while adjuvanted influenza vaccines are another type of flu shot.

The researchers also found an elevated risk of nonhemorrhagic stroke among people who received an influenza vaccine and did not get a COVID-19 vaccine, supporting the finding.

Rare Neurological Disorder Linked to COVID-19 Vaccination, Research Suggests

“The clinical significance of the risk of stroke after vaccination must be carefully considered together with the significant benefits of receiving an influenza vaccination,” the researchers said, adding later that “more studies are needed to better understand the association between high-dose or adjuvanted influenza vaccination and stroke.”

The study was published by the Journal of the American Medical Association. It was previously filed as a preprint.

Limitations include the exclusion of cases with COVID-19 in the 30 days prior to stroke as well as the restriction of the study to vaccinated people. The method researchers used, a self-controlled case series, used vaccinated people as both the primary group and the control group. Researchers counted strokes that occurred within 42 days of vaccination as being possibly linked to vaccination and strokes that happened between 43 days and 90 days after vaccination as unrelated to vaccination.

The paper included stroke cases between Aug. 31, 2022, and January or February 2023, depending on the type of stroke. After exclusions, 11,001 stroke cases were included.

The only conflicts of interest listed by the researchers were that some of them work for Acumen. The paper was funded by the FDA through an agreement for which Acumen is the contractor. “The FDA played a role in the design and conduct of the study; interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The FDA did not play a role in the collection, management, or analysis of the data,” according to the study.

Previous Findings

The possible stroke risk for Pfizer’s bivalent vaccine and the elderly was first reported in early 2023. The FDA and U.S. Centers for Disease Control and Prevention (CDC) said at the time a safety signal appeared in a government monitoring system.

The CDC later said data from the system suggested the elevated risk stemmed from receiving an influenza vaccine with a COVID-19 shot.

French researchers have said they examined whether receipt of a bivalent vaccine was linked to a higher rate of stroke and other cardiovascular events than the old vaccine versions and found that receipt of the former was actually linked to a lower rate.

“At 21 days after the booster dose, we found no evidence of an increased risk of cardiovascular events among the recipients of the bivalent vaccine as compared with recipients of the monovalent vaccine,” they said in a letter published by the New England Journal of Medicine.

Drs. Kathryn Edwards and Marie Griffin of Vanderbilt University, who were not involved in the FDA or French studies, said in an editorial this week that the results of the research were reassuring but that ongoing monitoring of influenza vaccines among older adults would “provide additional data on stroke risk.”

Using Cannabis Daily Linked to 42% Increase in Stroke Risk

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Cannabis is seen in a blue grinder.
A new study finds using cannabis daily can significantly increase your heart disease risk. Alberto Case/Getty Images
  • Using cannabis is associated with an increased risk of heart attack and stroke, independent of tobacco use, a study of 430,000 adults found.
  • People who used cannabis more frequently had a higher risk, but the risk was present even in people who used cannabis less than daily.
  • The cardiovascular risks were even present in cannabis users who had never used tobacco cigarettes or nicotine e-cigarettes.

Cannabis use may increase the risk of heart attack and stroke, a new study of over 430,000 U.S. adults found. This association was present even after researchers took into account tobacco use and other risk factors for cardiovascular disease.

Over 48 million Americans reported using cannabis at least once in 2019, with three in 10 people who use cannabis having cannabis use disorder, accordingTrusted Source to the Centers for Disease Control and Prevention.

Although cannabis remains illegal at the federal level, 24 states and the District of Columbia have legalized it for recreational use, with additional states allowing medical use of cannabis, aka marijuana.

This has led to an increase in the use of cannabis among adults over the past decade, even as cigarette smoking rates have dropped since the 1960s.

“Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks,” study author Abra Jeffers, PhD, a data analyst at Massachusetts General Hospital in Boston, said in a statement.

“However, previous research suggested that cannabis could be associated with cardiovascular disease,” she said. “In addition, smoking cannabis — the predominant method of use — may pose additional risks because particulate matter is inhaled.”

Heart-related risks of cannabis

In the study, published February 28 in the Journal of the American Heart AssociationTrusted Source, Jeffers and her colleagues reviewed data on 434,104 adults from 2016 to 2020 to examine the link between cannabis use and adverse cardiovascular outcomes (heart attack, stroke and coronary heart disease).

The data was collected through the Behavioral Risk Factor Surveillance System, a national survey conducted annually by the CDC.

Among all adults aged 18 to 74 years old, any cannabis use — whether smoked, ingested or vaporized — was associated with a higher risk of adverse cardiovascular outcomes, researchers found.

The risk was higher with more frequent cannabis use, but was present even among people who used it less often. For example, daily cannabis users had a 25% greater risk of heart attack, and a 42% higher risk of stroke, compared to non-users.

The results were similar even after researchers controlled for other cardiovascular risk factors such as use of tobacco cigarettes or nicotine e-cigarettes, alcohol consumption, body mass index (BMI), type 2 diabetes and physical activity level.

In a separate analysis, researchers found that cannabis users who had never smoked tobacco or used nicotine e-cigarettes still showed an increased risk of coronary heart disease, heart attack or stroke.

In addition, younger adults at risk for premature cardiovascular disease — men younger than 55 years old and women younger than 65 years old — who used cannabis had a 36% higher risk of coronary heart disease, heart attack or stroke.

Increased risk may come from “particulate matter” in cannabis

Dr. Geoffrey C. Williams, clinical professor of internal medicine at University of Michigan Health, said the results show “there is a strong and consistent effect of cannabis smoking on heart attacks and strokes — even in younger individuals.”

Part of this increased risk may be due to breathing in fine particulate matter, which has been shown to damage blood vessels and the heart.

“We know that low amounts of exposure to smoke, even secondhand cannabis or tobacco smoke, substantially increases risk for stroke and heart attack,” Williams told Healthline.

One studyTrusted Source in rats also showed that exposure to just one minute of secondhand cannabis smoke impaired the functioning of blood vessels.

Williams cautions that cannabis smoke contains more than just tetrahydrocannabinol (THC), the active component of cannabis. Those other chemicals may also have negative effects on the heart and blood vessels.

The bottom line: “When people consider taking anything, be aware of the effects of all the contents of the substance,” he said, adding that “smoking is never a safe way to take drugs.”

Smoke inhalation is just one potential way for cannabis to harm the heart and blood vessels, the authors of the new study point out.

For example, some research suggests that cannabis may have negative effects by activating cannabinoid receptorsTrusted Source found throughout the cardiovascular system. In addition, THC can affect blood flow, in a way that may increase the risk of stroke and heart attack.

Cannabis as a cardiovascular risk factor

The new study had some limitations, including its observational nature, which means researchers can’t show cause-and-effect, only that there is an association.

Also, researchers relied on participants to report their cardiovascular risk factors and whether they had a heart attack or stroke. They also didn’t have data on participants’ blood pressure or cholesterol levels, two other key cardiovascular risk factors.

However, Dr. Guy L. Mintz, director of Cardiovascular Health & Lipidology at Sandra Atlas Bass Heart Hospital at North Shore University Hospital in Manhasset, New York, pointed out that even without knowing blood pressure and cholesterol levels, researchers still saw a strong link between cannabis use and adverse cardiovascular outcomes.

However, people with uncontrolled blood pressure or high cholesterol may be at higher risk from cannabis. Additional studies would be needed to assess that.

Loren E. Wold, PhD, a professor in the Department of Surgery at The Ohio State University, in Columbus, Ohio, also thinks more research is needed on the heart-related effects of edibles.

Cannabis edibles can include gummies, brownies, cookies and other products, with some edibles having very high THC levels.

While the study included people who used cannabis edibles or vaped cannabis, the researchers didn’t look at the cardiovascular risks for these groups separately.

So, “there needs to be more work done on the type of edible, not just whether it’s an edible or not, but the actual type of edible,” Wold told Healthline.

We need to really look at “what the potential risks are of all the various types of cannabis products,” he said, “and that’s going to take a significant amount of time.”

Some of the shortcomings of the new study could be addressed in future research, such as by enrolling participants and following them from that point forward to see how many develop cardiovascular problems.

With this kind of prospective study, research teams could use medical records to verify whether a person had a heart attack or stroke, and measure blood pressure and other cardiovascular risk factors directly. They could also gather more detailed information about cannabis use, including frequency and types of products.

In spite of the limitations of the new study, Mintz said the findings are a wake-up call for both the general public and physicians about the potential risks of cannabis.

“This is an opportunity for people who engage in cannabis use, recreationally or medically, to talk to their doctor and review their other cardiovascular risks,” Mintz told Healthline, especially those who already know they are at higher risk of heart problems.

Physicians should also routinely ask patients about cannabis use, he said, the way they assess blood pressure, cholesterol, weight and other factors.

“Cannabis use could be considered another potential cardiovascular risk factor,” he said, “one that’s overlooked.”

Wold said the new findings will also allow people to weigh the risks and benefits of cannabis, which is especially important in middle-aged and older adults, who may have other cardiovascular risk factors.

“Cannabis products can be effective for treating sleeplessness or chronic pain,” said Wold. “But is using cannabis worth the risk of compromised cardiac function?”

Takeaway

In a study of over 430,000 U.S. adults, researchers found that cannabis use was associated with increased cardiovascular risks, including heart attack, stroke, and coronary heart disease. The risk was higher with more frequent cannabis use.

This was true even when researchers took into account other risk factors such as tobacco use, alcohol consumption, body mass index (BMI), type 2 diabetes, and physical activity level.

Even in people who had never used tobacco cigarettes or nicotine e-cigarettes, cannabis use was linked to a higher risk of adverse cardiovascular outcomes. Younger people saw a similar risk with cannabis use.

Acupuncture may help reduce stroke risk in people with rheumatoid arthritis.

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Research indicates that acupuncture may provide cardiovascular health benefits for people with rheumatoid arthritis. Kilito Chan/Getty Images

  • Rheumatoid arthritis is a debilitating disease and can affect the body in many ways, including negatively impacting the cardiovascular system.
  • Researchers based in Taiwan and China conducted a comparative study using data available on people with rheumatoid arthritis to see what sort of cardiovascular benefits acupuncture provided.
  • Acupuncture involves treating pain by inserting needles strategically in the body.
  • Their findings showed that people with rheumatoid arthritis who underwent acupuncture had a 43% reduced risk of having a stroke.

Rheumatoid arthritisTrusted Source (RA) is an autoimmune disease that can cause chronic joint pain, joint deformities, and inflammation.

According to the National Institutes of HealthTrusted Source (NIH), rheumatoid arthritis affects millions of people worldwide, with up to 1% of some countries’ population having rheumatoid arthritis. The NIH notes that between 25 to 27.5 people per 100,000 in the U.S. have rheumatoid arthritis.

With rheumatoid arthritis being so prevalent, researchers are looking for ways to treat the disease as well as some of the problems associated with the disease, such as cardiovascular disease.

Researchers in China and Taiwan recently accessed medical records to see if there are any trends related to people who both have rheumatoid arthritis and acupuncture treatment. While the study is observational, they did find that this group of people was less likely to experience a stroke.

The study is available in BMJ Open.

How acupuncture benefits rheumatoid arthritis

While there are a number of treatments available for rheumatoid arthritis, such as JAK inhibitors and corticosteroids, there is not a cure for the disease. There are some things people can do to get some degree of pain relief, though, such as getting massages or having an acupuncture treatment.

Acupuncture is an alternative form of medicine that has origins in traditional Chinese medicine. According to the NIHTrusted Source, it involves “applying small needles or pressure to specific points in the body.”

In addition to helping provide pain relief from rheumatoid arthritis, acupuncture can also treat other types of pain, mood disorders, nausea, and fibromyalgia.

Acupuncture provides relief by causing changes in the central nervous system. The NIHTrusted Source explains that acupuncture “inhibits the expression of pro-inflammatory cytokines (such as TNF-alpha)” and “promotes the expression of anti-inflammatory and tissue-repair factors.”

Since inflammation associated with rheumatoid arthritis factors into people with the disease being at a higher risk for cardiovascular disease, including ischemic strokes, a treatment that interrupts the inflammation process, such as acupuncture, may provide more than standard pain benefits.

To that end, the researchers used data from Taiwan’s Registry for Catastrophic Illness Patients Database for their study to see if there was any correlation between rheumatoid arthritis participants who had acupuncture and outcomes in terms of strokes.

The authors included people in the study who were at least 18 years old, had no disruption in health insurance, and had no history of stroke before the beginning of the study window.

The participant sample included 23,226 people with rheumatoid arthritis who were diagnosed between 1997 and 2010. Of that group, 12,266 underwent an average of 10 acupuncture treatments over the course of about 3 years.

The participant pool was mainly female, and while the researchers included adults of all ages, the 40-59 female age bracket made up the bulk of the participants.

After gathering this information, they next looked at what treatments the participants underwent over the study period as well as any major health events.

Acupuncture and stroke risk 

By the end of the monitoring period, more than 900 participants experienced an ischemic stroke. Ischemic strokes cut off the blood supply to the brain.

Of those participants, 341 people from the acupuncture group had an ischemic stroke. In comparison to the group that didn’t undergo acupuncture treatments, this comes out to a 43% reduced stroke risk.

When the researchers took a closer look at the data to see whether different demographics or medical conditions could factor into these findings, they did not see any evidence of this.

“The advantage of lowering ischaemic stroke incidence through acupuncture therapy in rheumatoid arthritis patients was independent of sex, age, types of drugs used, and comorbidities,” write the authors.

The authors also note that “causality could not be proven directly through our study design … [but it] offers important ideas for more comprehensive research in the future.”

Rheumatoid arthritis heightens heart disease risk

Dr. Rigved Tadwalkar, a board certified consultant cardiologist at Providence Saint John’s Health Center in Santa Monica, California, spoke with Medical News Today about the study.

Dr. Tadwalkar first touched on why rheumatoid arthritis can cause cardiovascular diseases such as strokes.

“Individuals with rheumatoid arthritis (RA) face an elevated risk of cardiovascular disease (CVD) due to several interconnected factors,” said Dr. Tadwalkar. “The chronic inflammation characteristic of RA extends beyond the joints, affecting blood vessels and promoting atherosclerosis.”

“This inflammatory process damages the vessel lining and promotes plaque formation, leading to narrowed arteries and an increased susceptibility to heart attacks and strokes,” Dr. Tadwalkar continued.

Dr. Tadwalkar found the study findings “intriguing.”

“We observe a potential association between acupuncture and a diminished risk of stroke in individuals managing rheumatoid arthritis,” commented Dr. Tadwalkar. “The study implies that acupuncture may play a significant role beyond conventional approaches, potentially influencing the overall health outcomes in this patient population.”

Further research needed before recommending acupuncture

Dr. Tadwalkar said that more research is needed into the benefits of acupuncture and rheumatoid arthritis.

“While it is premature to draw definitive conclusions, these findings prompt further exploration into the integration of alternative therapies in comprehensive strategies for cardiovascular risk reduction in individuals with rheumatoid arthritis,” said Dr. Tadwalkar.

Dr. Cheng-Han Chen, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California, also spoke with MNT.

Dr. Chen emphasized that this is an observational study and that more research is needed before the findings can be applied at a clinical level.

“These results warrant further study to investigate whether acupuncture may be beneficial for reducing stroke in a wider population,” said Dr. Chen.

“As with all observational studies, this study is not able to determine that acupuncture was causal to the reduction in stroke,” noted Dr. Chen. “In addition, it remains to be determined whether these findings are generalizable to a more ethnically diverse population.”

Even Moderate Exposure to Radon Tied to Increased Stroke Risk

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Exposure to even moderate concentrations of radon is associated with a significant increase in stroke risk, new research suggests.

An analysis of radon exposures in more than 150,000 postmenopausal women in the Women’s Health Initiative revealed a 14% higher stroke risk in those exposed to the highest concentrations compared with those exposed to the lowest concentrations. Even moderate concentrations of radon were associated with a 6% higher stroke risk.

Radon is the second leading cause of lung cancer, but little was known about how exposure to the gas might affect stroke risk in women. 

“Our research found an increased risk of stroke among participants exposed to radon above — and as many as 2 picocuries per liter (pCi/L) below — concentrations that usually trigger Environmental Protection Agency recommendations to install a home radon mitigation system,” senior author Eric A. Whitsel, MD, MPH, professor of epidemiology and medicine, University of North Carolina, Chapel Hill, said in a news release.

The study was published online on January 31, 2024, in Neurology.

Women Particularly Affected

Radon is a naturally occurring odorless radioactive gas produced when uranium or radium break down in rocks and soil. Its presence is increasing as a result of climate change, and it is increasingly being found in people’s homes. When inhaled, this air pollutant releases ionizing radiation in the lungs and is seen as second only to smoking as an established cause of lung cancer.

The National Radon Action Plan of the US Environmental Protection Agency (EPA) lays out testing and mitigation guidelines based on the known role of radon in lung carcinogenesis. But radon testing and mitigation are less common than recommended, and the EPA’s action plan doesn’t cover diseases other than lung cancer.

Compared with men, women have a higher rate of stroke and, in the US, typically spend about 11% more hours per day indoors at home, which investigators note highlights a “potential role of the residential environment among other risk factors specific to women.”

Researchers examined longitudinal associations between home radon exposure and incident stroke in 158,910 women at baseline (mean age 63.2 years; 83% White) over a mean follow-up of 13.4 years. During this time, participants experienced a total of 6979 strokes.

Participants’ home addresses were linked to radon concentration data drawn from the US Geological Survey and the EPA, which recommends that average indoor radon concentrations not exceed 4 pCi/L. 

The highest radon exposure group resided in areas where average radon concentrations were < 4 pCi/L; the middle exposure group lived in regions with average concentrations of 2-4 pCi/L; and the lowest exposure group lived in areas with average concentrations < 2 pCi/L. 

The researchers adjusted for demographic, social, behavioral, and clinical characteristics.

Public Health Implications

The incidence rates of stroke per 100,000 women in the lowest, middle, and highest radon concentration areas were 333, 343, and 349, respectively.

Stroke risk was 6% higher among those in the middle exposure group (adjusted hazard ratio [aHR], 1.06; 95% CI, 0.99-1.13) and 14% higher in the highest exposure group (aHR, 1.14; 95% CI, 1.05-1.22) compared with the lowest exposure group.

Notably, stroke risk was significant even at concentrations ranging from 2 to 4 pCi/L (P = .0004) vs < 2 pCi/L, which is below the EPA’s Radon Action Level for mitigation. 

The findings remained robust in sensitivity analyses, although the associations were slightly stronger for ischemic stroke (especially cardioembolic, small-vessel occlusive, and very large artery atherosclerotic) compared with hemorrhagic stroke.

“Radon is an indoor air pollutant that can only be detected through testing that measures concentrations of the gas in homes,” Whitsel said in the release. “More studies are needed to confirm our findings. Confirmation would present an opportunity to improve public health by addressing an emerging risk factor for stroke.”

The study lacked gender and racial/ethnic diversity, so the findings may not be generalizable to other populations. 

“Replication studies of individual-level radon exposures are needed to confirm this positive radon-stroke association,” the authors write. “Confirmation would present a potential opportunity to affect public health by addressing a pervasive environmental risk factor for stroke and thereby merit reconsideration of extant radon policy.”

Both too little and too much sleep tied to increased stroke risk

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  • Researchers investigated the link between sleep problems and stroke risk.
  • They found that sleep problems increased stroke incidence by as much as five times.
  • Further studies are needed to confirm the results.

Quality sleep is essentialTrusted Source for health. Sleep problems range from too short or too long sleep duration, difficulty falling and staying asleep, and symptoms such as snoring, snorting, and pauses in breathing.

Studies show that obstructive sleep apnea is associated with stroke. Whether other sleep orders are linked to stroke remains unknownTrusted Source.

Knowing more about how sleep problems may affect stroke risk could aid the development of preventative strategies.

Recently, researchers investigated the link between sleep problems and the incidence of acute strokeTrusted Source.

They found that the more sleep problems individuals had, the more likely they were to experience stroke. The study paper appears in the journal Neurology.

Dr. Adi Iyer, a neurosurgeon and neurointerventional surgeon at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study, told Medical News Today that, “[w]hile there may be independent physiological changes that occur with poor sleep predisposing to stroke, it is likely that overall sleep represents an epiphenomenon of known stroke risk factors such as obesity, older age, alcohol use, etc.”

“Sleep may be a modifiable risk factor for stroke and clinicians should assess patients’ sleep quality and duration,” he added.

Sleep problems and stroke risk

For the study, the researchers analyzed healthcare data from 1,799 participants who had experienced an ischemic stroke — the most common kind of stroke, in which a blood clot blocks an artery leading to the brain.

They also analyzed data from 439 people who experienced an intracerebral hemorrhage (ICH) — bleeding in brain tissue — and 4,496 controls who were matched according to age and sex. Participants were an average of 62 years old.

Finally, the researchers asked the participants about their sleep behaviors, including sleep duration and sleep quality, in the month before experiencing their stroke.

In the end, the researchers found that multiple sleep problems were linked to increased stroke incidence.

More specifically, those who slept less than 5 hours per night were three times more likely to have a stroke than those who slept for 7 hours. Meanwhile, stroke risk was doubled for those sleeping more than 9 hours per night compared to those sleeping 7 hours.

Sleep apnea — pauses in breathing multiple times per hour — was linked to a three times higher stroke risk. Napping for an hour or more was also linked to an 88% higher stroke risk when compared to no napping at all.

The researchers also found that those who snored were 91% more likely to have a stroke than those who did not, and that those who snorted were almost three times more likely to have a stroke than those who did not.

They further found that the more sleep problems individuals had, the more likely they were to experience stroke or ICH.

“Not only do our results suggest that individual sleep problems may increase a person’s risk of stroke but having more than five of these symptoms may lead to five times the risk of stroke compared to those who do not have any sleep problems,” warns Dr. Christine McCarthy of the University of Galway in Ireland, the leading author and corresponding author of the study.

The results remained valid even after the researchers controlled for potentially confounding factors, including depression, alcohol use, and physical activity.

What do sleep experts think?

MNT spoke with Dr. Thomas Kilkenny, director of the Institute Sleep Medicine at Staten Island University Hospital, not involved in the study, to understand more about the link between sleep problems and stroke risk.

He said that 80% of adult sleep is non-REM sleep, and that during this time, the cardiovascular system is controlled by the autonomic nervous system which reduces blood pressure, heart rate, and cardiovascular strain. These factors, he noted, have a protective effect on cardiovascular health.

He added that sleep disruption, including sleep apnea, insomnia, and shift work, may impair this protective effect by reducing time spent in non-REM sleep. He added: “When this occurs, there is a decrease in the [cardiovascular] recovery but also a significant increase [in] stress on the cardiovascular system.”

“Poor sleep quality, through [a] reduction in non-REM sleep, also activates a multitude of other mechanisms including intermittent hypoxia injury, blood pressure swings, cardiac arrhythmia, inflammation, insulin resistance, stress hormone activation, and hypercoagulability, all of which have the potential to provoke cardiovascular diseases including strokes.”

– Dr. Thomas Kilkenny

Dr. McCarthy also noted that “[s]leep is increasingly being recognized as the third pillar of health, along with diet and exercise, although it has not been as thoroughly researched.”

Nevertheless, she cautioned that it is difficult to tell whether sleep problems cause stroke risk factors or vice versa.

“For example,” she noted, “increased alcohol intake may cause disruptions in sleep quality, but impairments in sleep quality may result in increased use of alcohol as a sedative. Future interventional research is required to determine causal associations.”

Study limitations

When reflecting on their study’s limitations, Dr. McCarthy noted that one factor to keep in mind is potential bias, as”people reported their own symptoms of sleep problems, so the information may not have been accurate, subject to recall and misclassification bias.”

Dr. Kilkenny added that “[t]he major limitation is that the study findings are just associations and not a direct cause and effect.”

“This means that people with poor sleep quality are more likely to have a stroke, not necessarily that poor sleep directly causes the stroke,” he said.

“Further studies are needed. Likewise having insomnia, taking long naps, or being a long sleeper may be a sign of another health disorder that could be triggering the cardiovascular disease,” noted Dr. Kilkenny.

Further implications 

When asked about the study’s implications of the study, Dr. Kilkenny said it should be an “awakening” to patients and physicians on the importance of good quality sleep.

“The study results also give physicians an incentive to inquire about sleep habits when seeing patients in the office. Sleep is rarely discussed routinely in the office and physicians may be missing an opportunity to improve their patient’s health by picking up sleep disturbances sooner,” he added.

Dr. McCarthy noted:

“Our findings suggest that sleep disturbance symptoms may represent either risk factors for stroke, and/ or their presence identifies people at increased risk of stroke. The study does not show that sleeping problems cause stroke. It only shows an association. Given our findings, future studies should look at interventions for sleep problems, and their potential to reduce stroke risk.”