Obsessive Compulsive Disorder Ups Ischemic Stroke Risk in Later Life

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Adults with a diagnosis of obsessive compulsive disorder (OCD) may be at increased risk for ischemic stroke, according to findings published online May 27, 2021, in Stroke, the journal of the American Stroke Association.

Compared with adults who did not have OCD, those with the disorder were 3 times more likely to have an ischemic stroke.

“For decades, studies have found a relationship between stroke first and OCD later,” said Ya-Mei Bai, MD, PhD, a professor in the department of psychiatry at Taipei Veterans Hospital and National Yang Ming Chiao Tung University College of Medicine, Taiwan in an American Heart Association press release. “Our findings remind clinicians to closely monitor blood pressure and lipid profiles, which are known to be related to stroke in patients with OCD.”

In fact, Bai and colleagues note in the study the increasing body of evidence demonstrating an association between OCD and metabolic risk factors for stroke, including obesity, hypertension, and diabetes. They also write that "OCD following cerebrovascular accident has been commonly reported; however, the relationship between OCD and subsequent stroke has scarcely been investigated."

To investigate the temporal association between OCD and both ischemic and hemorrhagic stroke, investigators analyzed health record data collected between 2001 and 2010 by the Taiwan National Health Insurance Research Database to compare stroke risk between 28 064 adults with OCD and 28 064 adults matched for age, sex, and comorbidities who did not have OCD.

Participant's average age at diagnosis with OCD was 37 years, and women and men were nearly equally represented in the data. Researchers compared stroke risk between the two groups for up to 11 years.

• The study found that patients with OCD had an increased incidence of new-onset ischemic stroke (0.29% vs 0.09%, P<.001), but not hemorrhagic stroke (0.08% vs 0.05%, P=0.188), compared with the non-OCD controls.
• Charlson Comorbidity Index scores were higher among patients with OCD (P<.001) and the group also had higher all-cause clinical visits (P<.001) vs the non-OCD control group.
• Kaplan-Meier survival analyses found patients with OCD were more likely to develop ischemic (P,.001), but not hemorrhagic stroke (P=0.700) than controls without OCD.
• During the follow-up period, when compared with controls, patients with OCD had an elevated risk for ischemic stroke (hazard ratio [HR] = 3.02; 95% confidence interval [CI], 1.91-4.77).
• Notably, the researchers found that the difference between groups was more pronounced in adults in midlife (age 40-59 years) (HR, 2.66 [95% CI, 1.34–5.29]) and in the elderly (age ≥60 years) (HR, 3.46 [95% CI, 1.70–7.05].
• There was no difference in risk for hemorrhagic stroke found between groups.
• The investigators also found no relationship between either short- or long-term use of medications to treat OCD and increased risk for ischemic or hemorrhagic stroke.

The authors conclude that OCD was an "independent risk factor for ischemic stroke after adjustment for stroke-related comorbidities, including metabolic disorders and other severe mental diseases" and particularly in later life. They also call for further investigation to better understand the "pathomechanism" underlying the increase in risk.