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Front. Neurol. | doi: 10.3389/fneur.2018.00090

Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

 Ling Guan1, 2,  Jean-Paul Collet2, 3*, Garey Mazowita4, 5 and  Victoria Claydon6
  • 1Medicine, University of British Columbia, Canada
  • 2Pediatrics, BC Children's Hospital Research Institute, Canada
  • 3Medicine, University of British Columbia, Canada
  • 4Family and Community Medicine, Providence Health Care, Canada
  • 5Family Practice, University of British Columbia, Canada
  • 6Biomedical Physiology and Kinesiology, Simon Fraser University, Canada

Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of a limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory, and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors”, respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke, and thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.

Keywords: Autonomic Nervous System, stress, Heart rate variability, ischemic stroke, transient ischemic attack, prediction

Received: 30 Sep 2017; Accepted: 08 Feb 2018.

Edited by:

Ayrton R. Massaro, Hospital Sírio-Libanês, Brazil

Reviewed by:

Maurizio Acampa, Azienda Ospedaliera Universitaria Senese, Italy
Jan F. Scheitz, Charité Universitätsmedizin Berlin, Germany  

Copyright: © 2018 Guan, Collet, Mazowita and Claydon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Jean-Paul Collet, University of British Columbia, Medicine, Vancouver, V6H3N1, BC, Canada,