Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study

Smyth, A. et al. (2022) Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study. European Heart Journal, 43(3), pp. 202-209. (doi: 10.1093/eurheartj/ehab738) (PMID:34850877)

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Abstract

Aims: In INTERSTROKE, we explored the association of anger or emotional upset and heavy physical exertion with acute stroke, to determine the importance of triggers in a large, international population. Methods and results: INTERSTROKE was a case–control study of first stroke in 32 countries. Using 13 462 cases of acute stroke we adopted a case-crossover approach to determine whether a trigger within 1 hour of symptom onset (case period), vs. the same time on the previous day (control period), was associated with acute stroke. A total of 9.2% (n = 1233) were angry or emotional upset and 5.3% (n = 708) engaged in heavy physical exertion during the case period. Anger or emotional upset in the case period was associated with increased odds of all stroke [odds ratio (OR) 1.37, 99% confidence interval (CI), 1.15–1.64], ischaemic stroke (OR 1.22, 99% CI, 1.00–1.49), and intracerebral haemorrhage (ICH) (OR 2.05, 99% CI 1.40–2.99). Heavy physical exertion in the case period was associated with increased odds of ICH (OR 1.62, 99% CI 1.03–2.55) but not with all stroke or ischaemic stroke. There was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time, or day of symptom onset. Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive. Conclusion: Acute anger or emotional upset was associated with the onset of all stroke, ischaemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Langhorne, Professor Peter
Authors: Smyth, A., O’Donnell, M., Hankey, G. J., Rangarajan, S., Lopez-Jaramillo, P., Xavier, D., Zhang, H., Canavan, M., Damasceno, A., Langhorne, P., Avezum, A., Pogosova, N., Oguz, A., and Yusuf, S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
Published Online:01 December 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Heart Journal 43(3): 202-209
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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