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.

中文翻译：

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愤怒或情绪不安以及剧烈的体力消耗是中风的诱因：INTERSTROKE 研究。

目的 在 INTERSTROKE 中，我们探讨了愤怒或情绪不安以及剧烈体力消耗与急性中风的关联，以确定触发因素在大量国际人群中的重要性。方法和结果 INTERSTROKE 是一项针对 32 个国家的首次中风的病例对照研究。通过使用 13 462 例急性中风病例，我们采用病例交叉方法来确定症状出现 1 小时内（病例期）与前一天同一时间（对照期）的触发因素是否与急性中风相关。总共 9.2% (n = 1233) 的人感到愤怒或情绪不安，5.3% (n = 708) 的人在案例期间进行了剧烈的体力消耗。病例期间的愤怒或情绪不安与所有中风[比值比 (OR) 1.37，99% 置信区间 (CI)，1.15-1.64]、缺血性中风（OR 1.22，99% CI，1.00-1.49）的几率增加相关。 ）和脑出血（ICH）（OR 2.05，99% CI 1.40-2.99）。病例期间的剧烈体力消耗与脑出血的几率增加相关（OR 1.62，99% CI 1.03-2.55），但与所有中风或缺血性中风无关。地区、既往心血管疾病、危险因素、心血管药物、症状出现的时间或日期没有改变作用。与对照组期间未接触任何触发因素相比，接触两种触发因素相关的中风几率并不相加。结论 急性愤怒或情绪不安与所有卒中、缺血性卒中和脑出血的发生有关，而急性剧烈体力消耗仅与脑出血相关。