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Anger Increases Stroke Risk, Study Claims

But other experts find fault with the conclusion

MONDAY, Dec. 13, 2004 (HealthDayNews) -- An Israeli study suggests a link between experiencing an angry or frustrating moment and an immediate risk of stroke.

But several U.S. stroke experts said the study has shortcomings.

Neurologist Silvia Koton and her colleagues at Tel Aviv University interviewed 200 people hospitalized with ischemic strokes or transient ischemic events, both of which reduce blood flow to the brain because of clots. The researchers asked the patients whether they had experienced anger or negative emotions in the two hours before the "event." They also asked whether the patients had experienced similar feelings the day before and during the past year.

Some 30 percent of the patients reported anger or negative emotions, as well as a sudden change in body posture, in the two hours before the event, according to the report in Dec. 14 issue of Neurology.

The study indicated that exposure to such triggers could increase the risk of stroke by as much as 14-fold within the next two hours, Koton said. "Our research is the first comprehensive study on potential triggers for ischemic strokes," she added.

Dr. Louis Caplan is a professor of neurology at Harvard Medical School and a spokesman for the Academy of Neurology. He called the new study a pioneering effort because, while much research has been done on stress and heart disease, the stress-stroke link "is an understudied area."

However, he questioned the study's conclusions, noting that life in Israel -- where a suicide bomber may be around the next corner -- is stressful from the start. "This study says nothing about chronic stress, but there could be an effect of continued stress for a long time," he said.

Caplan did give the Israeli researchers high marks just for doing the study. "This is a tremendously neglected area," he said. "The interesting thing is that they studied it and found some relationship."

Elaine D. Eaker, an epidemiologist who has studied the link between anger and heart disease, had a tougher appraisal.

"If you ask someone who has just had a stroke or heart attack if they experienced stress right beforehand, the bias is that they will say yes,'" she said.

And Dr. Philip E. Stieg, chairman of the department of neurological surgery at Weill Medical College of Cornell University in New York City, called the study "more pop psychology than science."

"If the appropriate controls had been used in this study, which looked at only 200 people, then we would see how many people do not have strokes two hours after experiencing anger," Stieg said.

Koton defended the study's methodology: "We compared exposure to potential triggers during the two-hour period immediately before the onset of stroke symptoms with exposure in two different control periods, the same two-hour period on the day before stroke onset and average exposure in the last year."

More information

The American Stroke Association has more about stroke.

SOURCES: Silvia Koton, Ph.D, neurologist, Tel Aviv University, Israel; Louis Caplan, professor, neurology, Harvard Medical School, Boston; Elaine D. Eaker, president, Eaker Epidemiological Enterprises, Chili, Wisc.; Philip E. Stieg, M.D., chairman, department of neurological surgery, Weill Medical College of Cornell University, New York City; Dec. 14, 2004, Neurology
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