Evidence map›Paper›PMID 34850877›Full record

ArticleEuropean heart journal2022

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

Andrew Smyth, Martin O'Donnell, Graeme J Hankey, Sumathy Rangarajan, Patricio Lopez-Jaramillo, Denis Xavier, Hongye Zhang, Michelle Canavan, Albertino Damasceno, Peter Langhorne and 5 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.

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  11. Mental Stress and Cardiovascular Health-Part I.Journal of clinical medicine · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 11 institutions in 11 countries.

Andrew SmythPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada.ORCID 0000-0002-3320-8292
Martin O'DonnellPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada.
Graeme J HankeyMedical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia.ORCID 0000-0002-6044-7328
Sumathy RangarajanPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada.ORCID 0000-0003-2420-5986
Patricio Lopez-JaramilloInstituto de Investigaciones Masira, Escuela de Medicina, Universidad de Santander (UDES), Calle 70 N0 55-210, Bucaramanga, Colombia.ORCID 0000-0002-9122-8742
Denis XavierSt John's Medical College and Research Institute, 100 Feet Rd, John Nagar, Koramangala, Bangalore, India.
Hongye ZhangBeijing Hypertension League Institute, Fuxingroad Road 36A, Beijing, China.
Michelle CanavanHRB Clinical Research Facility Galway, School of Medicine, NUI Galway, University Road, Galway, Ireland.ORCID 0000-0001-9445-0181
Albertino DamascenoFaculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyere, Maputo, Mozambique.ORCID 0000-0003-0925-494X
Peter LanghorneAcademic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, 84 Castle Street, Glasgow, UK.
Alvaro AvezumHospital Alemao Oswaldo Cruz, R. Treze de Maio, 1815-Bela Vista, Sao Paulo, Brazil.
Nana PogosovaNational Medical Research Center of Cardiology, 3-Ya CherepkovskayaUlitsa, 15A, Moscow, Russia.ORCID 0000-0002-4165-804X
Aytekin OguzDepartment of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Dumlupinar Mahallesi, D100 Karayolu No. 98, Istanbul, Turkey.
Salim YusufPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, 2387 Barton Street East, Hamilton, ON, Canada.
INTERSTROKE investigators
Ollscoil na Gaillimhe – University of Galway · IEPopulation Health Research Institute · CAEduardo Mondlane University · MZGlasgow Royal Infirmary · GBHospital Alemão Oswaldo Cruz · BRIstanbul Medeniyet University · TRNational Medical Research Center of Cardiology · RUShanghai Institute of Hypertension · CNSt.John's Medical College Hospital · INThe University of Western Australia · AUUniversidad De Santander · CO

Funding

CIHR
6 · The paper itself

Abstract

aimsIn 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

resultsINTERSTROKE 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.

conclusionAcute 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.

Indexed as

Brain IschemiaStrokeAngerCase-Control StudiesHumansPhysical ExertionRisk FactorsAngerExertionStrokeTriggers

Identifiers

PMID34850877
PMCPMC10503880
OpenAlexW3215286804

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.