Anxiety disorders, PTSD, and risk of first-ever stroke: A meta-analysis of 11 million participants

Anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) involve chronic fear and stress-related dysregulation that may increase vascular risk, yet their association with stroke and stroke type has not been systematically evaluated. We aimed to quantify associations between anxiety and related disorders and stroke risk, distinguishing clinical diagnoses from self-reported symptom-based measures.

Databases were searched until 1 January 2026. We included longitudinal studies defining anxiety disorders, OCD or PTSD using DSM/ICD-based clinical diagnoses or validated self-reported symptom-based measures, and reporting hazard ratios (HRs) for first-ever stroke. HRs for clinical diagnoses and self-reported symptom-based measures were pooled separately. Subgroup analyses examined variation by sex, stroke type, and geographical region. Sensitivity analyses explored heterogeneity and adjustment for cardiovascular risk factors and depression.

Twenty-three cohort studies including 11,181,338 participants were included. Clinically diagnosed anxiety disorders were associated with increased stroke risk (HR 1.29, 95% CI 1.14-1.46). PTSD showed a stronger association (HR 1.50, 95% CI 1.31-1.72). OCD evidence was limited to one study and synthesised narratively. Combined, these disorders were associated with increased stroke risk (HR 1.38, 95% CI 1.28-1.50). Associations were observed for ischaemic stroke (HR 1.34, 95% CI 1.13-1.58), whereas haemorrhagic stroke did not reach statistical significance (HR 1.24, 95% CI 0.95-1.62). Associations persisted after adjustment for cardiovascular risk factors and depression.

Anxiety disorders and PTSD were associated with increased stroke risk, particularly ischaemic stroke. OCD-specific evidence was limited. Findings suggest that these disorders may represent vascular risk markers. Further studies are needed to establish causality.