Anger or emotionally upsetting events may precede and trigger the onset of stroke, according to a new study reported in the European Heart Journal.¹

INTERSTROKE is a large global study conducted across 32 countries. This analysis included 13,462 patients with acute first stroke i.e., within 5 days of development of symptoms and confirmed by neuroimaging within one week of presentation, and completed questionnaires within 72 hours of hospital admission. Using a case-crossover study design, the researchers sought to examine any association between anger or emotional upset and heavy physical exertion with acute stroke within one hour before the onset of symptoms and during the corresponding one-hour period the day before. Anger or emotional upset was reported by 1233 (9.2%) patients, while 708 (5.3%) reported heavy physical exertion within the time period under study. The corresponding numbers during the control period were 1111 (8.3%) patients and 725 (5.3%), respectively.

Anger or emotional upset within one hour of symptom onset was associated with increased risk for all stroke types (odds ratio 1.37), ischemic stroke (OR 1.22) and intracerebral hemorrhage (ICH) (OR 2.05). These patients were younger, highly educated and were under stress at the time of study entry. They had greater probability of being diabetic, hypertensive, depressed or have heart disease and were not compliant to medications. Heavy physical exertion was found to be associated with increased risk only for ICH (OR 1.62), but not with ischemic stroke or all stroke. These patients were mostly younger, male and current smokers but not diabetic. Their baseline physical activity levels were higher. In patients exposed to both, no additive effects were evident. This effect persisted regardless of the time and day of stroke, cardiovascular medications and several cardiovascular risk factors.

Anger is a negative state of mind. It is a state of sympathetic overactivity. Anger can be expressive or suppressive. Expressive anger causes plaque rupture and precipitate acute heart attack or stroke, while suppressive anger acts like a slow poison causing  chronic sympathetic overactivity that helps plaque formation; it may cause ulcers, hypertension, depression. Anger recall is as bad as anger itself. Both are dangerous. The answer is anger management and not expression nor suppression of anger, as Dr KK often said.

Stress also generates anger. Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress can only be managed by either changing the situation or changing the interpretation or living a yogic lifestyle in such a way that it does not affect the body. He frequently extolled the benefits of a parasympathetic lifestyle, which can be achieved by yoga, slow and deep breathing exercises, meditation (by thinking differently, thinking opposite and thinking positively), satvik diet etc. Letting go of desires, expectations is another way of achieving a parasympathetic state.

A component of the Formula of 80 devised by him, is to “do 80 cycles of parasympathetic breathing (slower and deeper breathing)” to shift from resting sympathetic (disturbed) to parasympathetic (relaxed) mode.

Reference

1. Smyth A, et al. Anger or emotional upset and heavy physical exertion as triggers of stroke: the INTERSTROKE study. Eur Heart J. 2021 Dec 1;ehab738.  doi: 10.1093/eurheartj/ehab738.