Nine factors linked to stroke risk
A massive team of international collaborators investigated potentially modifiable risk factors for acute stroke among 26,919 participants in 32 countries. Researchers identified 10 potentially modifiable risk factors that collectively accounted for 90.7 percent of all strokes, 91.5 percent of ischemic stroke, and 87.1 percent of intracerebral hemorrhagic stroke worldwide. The 10 factors include 1) hypertension, 2) lack of regular physical activity, 3) high apolipoprotein B/A1 ratio, 4) low scores for the modified Alternative Healthy Eating Index, 5) high waist-to-hip ratio, 6) current smoking, 7) psychosocial factors including stress, life events, and depression, 8) cardiac ailments, 9) high alcohol consumption, and 10) history of diabetes mellitus. Of these, the three factors with the highest ability to predict acute stroke included hypertension, lack of physical activity, and high apolipoprotein B/A1 ratio. After plowing through the report, the good news is that embracing healthy lifestyle choices can vastly reduce your risk of acute stroke.
Emotional upset + heavy physical exertion increases heart attack risk
People who experience anger or emotional upset and/or engage in heavy physical exertion appear to be at heightened risk of a heart attack. Researchers in the INTERHEART Study used data from 12,461 patients with an average age of 58 years across 52 countries who experienced an acute myocardial infarction (that is, a heart attack) to see if emotional upset and/or engaging in heavy physical exertion would trigger a heart attack. Each patient served as his or her own control. Shortly after a heart attack began, all patients were asked if they had experienced anger or emotional upset in the 1 hour prior to the beginning of the heart attack. Patients also were asked if they had experienced anger or emotional upset in the same 1 hour period on the day prior to the heart attack. The patients answered similar questions about engaging in heavy physical exertion during the 1 hour before the heart attack or on the previous day.
Heavy physical exertion 1 hour before a heart attack predicted a 131 percent higher odds of a subsequent heart attack compared to heavy physical exertion during the previous day. Experiencing anger or emotional upset in the 1 hour before the heart attack predicted a significant 144 percent higher odds of a heart attack compared anger or emotional upset at the same time period the previous day. Patients who reported both heavy physical activity and anger or emotional upset had significant 205 percent higher odds of a heart attack. Thus, both heavy physical exertion and anger or emotional upset may serve as triggers for a heart attack.
Emotional upset or heavy physical exertion increases stroke risk
Data from INTERSTROKE studies reveal 10 modifiable risk factors that collectively account for over 90 percent to total strokes worldwide (see first paragraph above). However, it’s much less clear what immediately precipitates acute stroke. INTERSTROKE investigators addressed this issue with data from 13,462 patients with an average of 62 years with first-time stroke cases in 32 countries. First-time stroke patients were queried immediately after stroke onset if they were angry or emotionally upset or engaged in heavy physical exertion in the 1 hour immediately prior to the onset of their stroke. Patients were also queried with the same questions but for the corresponding time during the previous day.
Compared to patients who reported no anger or emotional upset on the previous day, patients who reported anger or emotional upset immediately preceding a stroke the following day had a significant 37 percent higher odds of having a stroke of any type, 22 percent higher odds of an ischemic stroke, and 105 percent higher odds of a hemorrhagic stroke. Heavy physical exertion immediately prior to a stroke predicted a significant 62 percent greater odds of a hemorrhagic stroke. The effects of anger or emotional upset and heavy physical activity were not additive regarding odds of stroke risk. The message here: 1) Learn to manage episodes of major anger or emotional upset to avoid getting a stroke; 2) If you’re in poor physical shape, think twice about shoveling the one foot of dense, spring snow from your sidewalk and driveway. Or at least, go slowly.
Pathways for triggering a stroke
An editorial that accompanied the previous INTERSTROKE study noted that anger, emotional upset, and physical activity could trigger a stroke via four pathways: 1) sympathetic nervous system activation that leads to blood vessel constriction, 2) high blood pressure, 3) plaque rupture with plaque materials lodging in the brain, and 4) heart arrhythmias that could create coagulated materials that could lodge in the brain.
Negative emotions can stiffen blood vessels
Anger can trigger cardiovascular events, such as heart attack and stroke. The underlying reason(s) are unclear. Researchers in New York tested whether induced anger, anxiety or sadness could induce adverse responses in the endothelium that lines blood vessels leading to stiffened blood vessels. Endothelial dysfunction predicts worse cardiovascular health. Provoked anger but not anxiety or sadness decreased endothelial function over a period of 40 minutes compared to the control condition. While 40 minutes of harm to the endothelial may be inconsequential, chronic anger might lead to chronic endothelial insults and diminished cardiovascular health.
What to do
You may have heard of “heart attack snow.” The heavy physical exertion from shoveling snow may trigger a heart attack or stroke. Older snow shovelers in poor physical condition are likely at even greater risk. It’s also possible that you could get so mad about something that you’d have a heart attack or stroke. You might recall this blog post the next time you’re about to blow a gasket. If you can, step aside (physically or emotionally), breathe deeply, and count to 10. Then deal your situation more resourcefully.
