These findings suggest that ignoring depression and anxiety is probably not good medical practice

Professor Robert Carney

And there was no apparent link between mood disorders and an increased risk of the mini-strokes that sometimes precede a major attack.

The findings are from an on-going study focusing on 2,124 middle-aged men who live in the Caerphilly area of south Wales.

Each was subjected to a battery of physical and psychological tests, and then monitored over the course of the next 14 years.

In that time 137 strokes occurred, including 17 which were fatal.

Risk factors

In general, men who had strokes were older, heavier and had higher blood pressure levels than men who did not have strokes.

The men who had strokes were also more likely to be current smokers and to have at least one other chronic disease.

However, analysis of the data also revealed that they had also reported more symptoms of anxiety and depression. This was particularly true among those who died from their stroke.

The worse the depression and anxiety, the greater the risk.

Professor Robert Carney, of Washington University School of Medicine in St Louis, has examined the findings.

He believes there are several possible explanations for the link between depression and fatal strokes.

He said: "Depressed people often don't take medicines as prescribed so some of the men may not be taking medicines for high blood pressure, thereby increasing their risk for stroke."

Nervous system

However, there is also evidence to suggest that depression and anxiety has an effect on the way the autonomic nervous system works.

This system regulates heart rate and the contraction of the blood vessels.

"Those changes may produce alterations that contribute to the severity of stroke or heart attack."

Professor Carney said that the findings of the study should impress on both doctors and patients the need for vigilance.

Depression and anxiety are often downplayed by physicians who fail to ask about psychological health and patients who are reluctant to discuss depression.

Professor Carney said: "These findings suggest that ignoring depression and anxiety is probably not good medical practice."

"Psychological health should be evaluated the same way we evaluate any medical risk factor - such as high blood pressure or smoking."

The research is published in Stroke: Journal of the American Heart Association.