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

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...

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Autores principales: Smyth, Andrew, O’Donnell, Martin, Hankey, Graeme J, Rangarajan, Sumathy, Lopez-Jaramillo, Patricio, Xavier, Denis, Zhang, Hongye, Canavan, Michelle, Damasceno, Albertino, Langhorne, Peter, Avezum, Alvaro, Pogosova, Nana, Oguz, Aytekin, Yusuf, Salim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503880/
https://www.ncbi.nlm.nih.gov/pubmed/34850877
http://dx.doi.org/10.1093/eurheartj/ehab738
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author Smyth, Andrew
O’Donnell, Martin
Hankey, Graeme J
Rangarajan, Sumathy
Lopez-Jaramillo, Patricio
Xavier, Denis
Zhang, Hongye
Canavan, Michelle
Damasceno, Albertino
Langhorne, Peter
Avezum, Alvaro
Pogosova, Nana
Oguz, Aytekin
Yusuf, Salim
author_facet Smyth, Andrew
O’Donnell, Martin
Hankey, Graeme J
Rangarajan, Sumathy
Lopez-Jaramillo, Patricio
Xavier, Denis
Zhang, Hongye
Canavan, Michelle
Damasceno, Albertino
Langhorne, Peter
Avezum, Alvaro
Pogosova, Nana
Oguz, Aytekin
Yusuf, Salim
author_sort Smyth, Andrew
collection PubMed
description 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.
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spelling pubmed-105038802023-09-16 Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study Smyth, Andrew O’Donnell, Martin Hankey, Graeme J Rangarajan, Sumathy Lopez-Jaramillo, Patricio Xavier, Denis Zhang, Hongye Canavan, Michelle Damasceno, Albertino Langhorne, Peter Avezum, Alvaro Pogosova, Nana Oguz, Aytekin Yusuf, Salim Eur Heart J Clinical Research 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. Oxford University Press 2021-12-01 /pmc/articles/PMC10503880/ /pubmed/34850877 http://dx.doi.org/10.1093/eurheartj/ehab738 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Smyth, Andrew
O’Donnell, Martin
Hankey, Graeme J
Rangarajan, Sumathy
Lopez-Jaramillo, Patricio
Xavier, Denis
Zhang, Hongye
Canavan, Michelle
Damasceno, Albertino
Langhorne, Peter
Avezum, Alvaro
Pogosova, Nana
Oguz, Aytekin
Yusuf, Salim
Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study
title Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study
title_full Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study
title_fullStr Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study
title_full_unstemmed Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study
title_short Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study
title_sort anger or emotional upset and heavy physical exertion as triggers of stroke: the interstroke study
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503880/
https://www.ncbi.nlm.nih.gov/pubmed/34850877
http://dx.doi.org/10.1093/eurheartj/ehab738
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