Abstract
J Am Heart Assoc. 2026 Jan 30:e039035. doi: 10.1161/JAHA.124.039035. Online ahead of print.
ABSTRACT
BACKGROUND: Novel risk factors for stroke, such as occupation, are increasingly under exploration. We investigate if specific occupational exposures and settings increase the risk of developing small-vessel disease (SVD), including SVD-related strokes.
METHODS: We performed a systematic review on stroke-occupation associations and then analyzed data from patients presenting to Lothian stroke services with mild ischemic stroke (modified Rankin Scale score ≤2). We performed magnetic resonance imaging and inquired about occupational status. We assessed relationships between high-risk occupations (per Control to Substances Hazardous to Health guidelines) and standard occupational classifications (per Standard Occupational Classifications criteria) against white matter hyperintensity volumes, SVD score, and stroke subtype.
RESULTS: Our systematic review identified 37 papers assessing occupations/broad occupational classifications (n=13), psychosocial work-related factors (n=11), and occupational exposure to hazardous substances (n=13). We then analyzed data from 414 participants and found, after adjustment for age, hypercholesterolemia, socioeconomic status, years of education, hypertension, diabetes, and smoking history, that high-risk occupations were associated with higher SVD scores (odds ratio, 1.64 [95% CI, 1.07-2.54]; n=357; P=0.02) but not for lacunar stroke subtype (odds ratio, 1.03 [95% CI, 0.64-1.67]; n=358; P=0.90) or white matter hyperintensity volume (% intracranial volume) (β=-0.003 [95% CI, -0.015 to 0.008]; n=357; P=0.60). Examples of high-risk occupations include drivers, engineers, and skilled trade workers. No associations were found for standard occupational classifications.
CONCLUSIONS: This systematic review shows limited data on stroke-occupation associations. Our analysis showed that high-risk occupations are associated with higher SVD scores but not stroke subtype.
REGISTRATION: URL: www.crd.york.ac.uk/PROSPERO; Unique Identifier: 42024466671.
PMID:41614311 | DOI:10.1161/JAHA.124.039035