Anger, upset and heavy exertion identified as stroke triggers

One in 11 stroke survivors experience a period of anger, upset in the hour leading up to it, a global study has found.

The research, co-led by the National University of Ireland, Galway, also found that every one in 20 patients were engaged in heavy exertion.

The suspected triggers have been identified as part of the global Interstroke study - the largest research project of its kind. The findings were published in the European Heart Journal.

Researchers analysed 13,462 cases of acute stroke, involving patients from a range of ethnic backgrounds in 32 countries, including the UK and Ireland.

According to most recent data, over 100,000 strokes occur in the UK each year, leading to 38,000 deaths. About 1.3 million people in the UK are survivors of stroke.

An estimated 30,000 people in Ireland are living with disabilities as a result of a stroke. In addition, 7,500 Irish people have a stroke and around 2,000 of these people die.

One of the lead researchers was Andrew Smyth, professor of clinical epidemiology at NUI Galway, said that despite advances in research, it “remains difficult to predict when a stroke will occur.”

He said: "Many studies have focused on medium- to long-term exposures, such as hypertension, obesity or smoking. Our study aimed to look at acute exposures that may act as triggers."

The research analysed patterns in patients who suffered ischemic stroke - the most common type of stroke, which occurs when a blood clot blocks or narrows an artery leading to the brain, and also intracerebral haemorrhage - which is less common and involves bleeding within the brain tissue itself.

Professor Smyth continued: "Our research found that anger or emotional upset was linked to an approximately 30% increase in risk of stroke during one hour after an episode - with a greater increase if the patient did not have a history of depression.

"The odds were also greater for those with a lower level of education.

"We also found that heavy physical exertion was linked to an approximately 60% increase in risk of intracerebral haemorrhage during the one hour after the episode of heavy exertion.

"There was a greater increase for women, and less risk for those with a normal BMI.

"The study also concluded that there was no increase with exposure to both triggers of anger and heavy physical exertion."

Two of the study’s collaborators, Dr Michelle Canavan, consultant stroke physician at Galway University Hospitals, Martin O'Donnell, professor of neurovascular medicine at NUI Galway, have encouraged people to focus on maintaining a “healthy lifestyle” by practicing “mental and physical wellness at all ages.”

Dr Canavan said: "Our message is for people to practise mental and physical wellness at all ages.

"But it is also important for some people to avoid heavy physical exertion, particularly if they are high-risk of cardiovascular, while also adopting a healthy lifestyle of regular exercise."

"Some of the best ways to prevent stroke are to maintain a healthy lifestyle, treat high blood pressure and not to smoke," Prof O'Donnell said.

"But our research also shows other events such as an episode of anger or upset or a period of heavy physical exertion independently increase the short-term risk.

"We would emphasise that a brief episode of heavy physical exertion is different to getting regular physical activity, which reduces the long-term risk of stroke."

A comment from our CEO Nanette Mellor: “A certain amount of stress or physical exertion in itself should not automatically lead to a stroke within a reasonably healthy person.

According to The Brain Charity, have similarly advised sustaining a healthy and balanced lifestyle as the best means of preventing a stroke.

The charity’s CEO, Nanette Mellor, said: “A certain amount of stress or physical exertion in itself should not automatically lead to a stroke within a reasonably healthy person.

“However, it might be the case that an individual has a history of stroke within their family and despite this continues to lead an unhealthy, very stressful or inactive lifestyle. This can be a very deadly combination.

“Stroke is a major cause of death in the UK, and lifestyle factors play a huge part. The good news is that we can really mitigate our risk through eating well, exercising and taking time out to enjoy the world around us and spending time with those that mean the most to us.”

For guidance around what to do if someone experiences a stroke, see the Stroke Association’s act FAST guidance: https://www.stroke.org.uk/what-is-stroke/what-are-the-symptoms-of-stroke