Emotional, physical stresses trigger stroke | 情緒、身體壓力觸發中風

Saturday December 4, 2021 (jkzx.com/healthabc.com) — Emotional stress and physical exertion or stress have been known for long to increase risk of cardiovascular events.  A new study has further found that these stresses can actually trigger or induce stroke in about 15% cases.

The study led by Andrew Smyth, who is affiliated with medical organizations in both Canada and Ireland at the time, and colleagues from many other countries shows that anger or emotional upset was experienced during one hour before strokes occurred in 9.2% patients while physical exertion in 5.3%.

The researchers, or INTERSTROKE investigators, analyzed data from 13,462 acute stroke patients in 32 countries and found anger or emotional upset was correlated with 37% increased risk of all strokes, 22% increased risk of ischemic stroke (vascular blockage) and 105% elevated risk of intracerebral hemorrhage (vascular bleeding).

Heavy physical exertion was found to increase the risk of intracerebral hemorrhage by 62%. But the physical stress was not associated with all strokes or ischemic stroke.

The two types of stresses, anger/emotional upset and heavy physical exertion do not have an additive effect on the risk of strokes.  The risk associated with these triggers was not affected by region, prior cardiovascular disease, other risk factors, use of cardiovascular medications, time/day of symptom onset.

Anger/emotional upset and heavy physical exertion are acute triggers for strokes.  But they are responsible for a small percentage of the risk.   Another report published in an 2016 issue of Lancet also by TERSTROKE investigators shows that ten risk modifying factors contribute to about 90.7% of the risk of stroke (91·5% for ischemic stroke, 87·1% for intracerebral hemorrhage).

In that study, INTERSTROKE investigators identified the following chronic risk modifying factors

  • Previous history of hypertension or high blood pressure (140/90 mmHg or higher.  On average high blood pressure boosts the risk of stroke by 198%
  • Regular physical activity.  Those who engage in regular physical activity was 40% less likely to suffer a stroke.
  • High ratio of apolipoprotein (Apo)B to ApoA1 can increase the stroke risk by 84%.
  • High modified Alternative Healthy Eating Index was associated with 40% reduced risk of stroke. (This observation seems to underestimate the impact of diet.  It is known that a plant-based diet can almost eliminate vascular disease by 100%.  Similarly, a plant-based diet may eliminate most stroke.  Both types of stroke, ischemic stroke and hemorrhage stroke are closely related to diet.
  • High waist-to-hip ratio ups the risk by 44%.
  • Psychosocial factors are a big risk factors and can increase stroke risk by 120%.
  • Current smoking was associated with 67% increased risk of stroke.
  • Cardiac causes are also a big risk factor, which can increase the stroke risk by 217%.  That means is a person has had cardiac events before, he has to face a much higher risk of stroke.
  • High or heavy episodic alcohol drinking can increase the stroke by 109%.
  • Diabetes mellitus only very slightly ups the risk of stroke (16%)

The report says that the associations are consistent across regions, gender, and age groups.

Hypertension is more associated with intracerebral hemorrhage (vascular bleeding) whereas current smoking, diabetes mellitus, apolipoproteins, and cardiac causes are more correlated with ischemic stroke (vascular blockage).  These observations make sense.

情緒、身體壓力觸發中風

2021 年 12 月 4 日星期六 (jkzx.com/healthabc.com)——長期以來,人們都知道情緒壓力和體力消耗或壓力會增加心血管事件的風險。一項新研究進一步發現,這些壓力實際上會引發或誘發中風 (在大約 15% 的中風病例中)。

由當時隸屬於加拿大和愛爾蘭醫療組織的 Andrew Smyth 和來自許多其他國家的同事領導的研究表明,9.2% 的患者在中風前一小時內感到憤怒或情緒不安,而在5.3%。

研究人員或 INTERSTROKE 研究人員分析了來自 32 個國家/地區的 13,462 名急性中風患者的數據,發現憤怒或情緒不安與所有中風風險增加 37%、缺血性中風(血管阻塞)風險增加 22% 和風險增加 105% 相關腦出血(血管出血)。

研究發現,劇烈的體力消耗會使腦出血的風險增加 62%。但身體壓力與所有中風或缺血性中風無關。

兩種類型的壓力,憤怒/情緒不安和重體力消耗對中風的風險沒有附加影響。與這些觸發因素相關的風險不受地區、既往心血管疾病、其他風險因素、心血管藥物的使用、症狀出現的時間/天數的影響。

憤怒/情緒不安和劇烈的體力消耗是中風的急性誘因。但他們對一小部分風險負有責任。同樣由 TERSTROKE 研究人員在 2016 年出版的《柳葉刀》雜誌上發表的另一份報告顯示,10 個風險調節因素導致了約 90.7% 的中風風險(缺血性中風為 91·5%,腦出血為 87·1%)。

在該研究中,INTERSTROKE 研究人員確定了以下慢性風險改變因素

  • 既往有高血壓或高血壓病史(140/90 mmHg 或更高。平均而言,高血壓會使中風風險增加 198%
  • 定期進行體育鍛煉。那些經常進行體育鍛煉的人患中風的可能性降低了 40%。
  • 載脂蛋白 (Apo)B 與 ApoA1 的高比例可使中風風險增加 84%。
  • 高改良替代健康飲食指數與中風風險降低 40% 相關。 (這一觀察似乎低估了飲食的影響。眾所周知,植物性飲食幾乎可以 100% 消除血管疾病。同樣,植物性飲食可以消除大多數中風。兩種類型的中風、缺血性中風和出血中風與飲食密切相關。
  • 高腰臀比會使風險增加 44%。
  • 心理社會因素是一個很大的風險因素,可以使中風風險增加 120%。
    目前吸煙與中風風險增加 67% 相關。
  • 心臟原因也是一個很大的危險因素,可使中風風險增加 217%。這意味著一個人以前有過心臟事件,他必鬚麵臨更高的中風風險。
  • 大量飲酒或大量飲酒可使中風增加 109%。
  • 糖尿病只會略微增加中風風險 (16%)

報告稱,這些關聯在不同地區、性別和年齡組之間是一致的。

高血壓與腦內出血(血管出血)更相關,而目前吸煙、糖尿病、載脂蛋白和心臟原因與缺血性中風(血管阻塞)更相關。這些觀察是有道理的。

 

Current study:

Andrew Smyth, Martin O’Donnell, Graeme J Hankey, Sumathy Rangarajan, Patricio Lopez-Jaramillo, Denis Xavier, Hongye Zhang, Michelle Canavan, Albertino Damasceno, Peter Langhorne, Alvaro Avezum, Nana Pogosova, Aytekin Oguz, Salim Yusuf, on behalf of the INTERSTROKE investigators, Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study, European Heart Journal, 2021;, ehab738, https://doi.org/10.1093/eurheartj/ehab738

https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehab738/6447061?redirectedFrom=fulltext

The 2016 report

Multicenter Study

. 2016 Aug 20;388(10046):761-75.

doi: 10.1016/S0140-6736(16)30506-2. Epub 2016 Jul 16.

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Affiliations

https://pubmed.ncbi.nlm.nih.gov/27431356/

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