Anger, hostility and risk of stroke: a meta-analysis of cohort studies

Chen, Hanze; Zhang, Beidi; Xue, Weishuang; Li, Jinwei; Li, Yuru; Fu, Kailei; Chen, Xinxin; Sun, Miao; Shi, Han; Tian, Li; Wang, Teng

doi:10.1007/s00415-019-09231-1

Cited by 13 publications

(13 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Trained interviewers ascertained the smoking status (current [more than one cigarette per day], past, or never), alcohol intake status (current [more than once per week], past, or never), and medication status. BMI was computed as body weight (kg) divided by height (m) 2 . Welltrained observers measured the systolic and diastolic blood pressures in the right arm using standard mercury sphygmomanometers.…”

Section: Measurements Of Anger Expression Pss and Stroke Risk Factorsmentioning

confidence: 99%

Impact of Perceived Social Support on the Association Between Anger Expression and the Risk of Stroke: The Circulatory Risk in Communities Study (CIRCS)

Tezuka

Kubota

Ohira

et al. 2023

Journal of Epidemiology

View full text Add to dashboard Cite

Background: Anger has been suggested as a risk factor for stroke. Perceived social support (PSS) may relieve anger, thus reducing the risk of stroke; however, evidence supporting this is limited. We aimed to examine whether PSS modifies the risk of stroke associated with anger expression.Methods: A cohort study was conducted among 1,806 community residents aged 40-74 years who received a cardiovascular risk survey including anger expression in 1997. A Cox proportional hazards model was applied to the participants with low and high PSS to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the risks of total stroke and its subtypes based on total anger expression after adjusting for known stroke risk factors. Results:The median follow-up duration was 18.8 years, with 51 incident strokes. Among the participants with low PSS, anger expression had a positive association with the total stroke risk:The multivariable HR per SD increment of total anger expression was 1.43 (95% CI, 1.13-1.82).In contrast, no association was identified among those with high PSS. The corresponding HR was 0.83 (95% CI, 0.49-1.40), with a significant interaction between low and high PSS (p = 0.037).Similar associations regarding the risk of ischemic stroke were found. Conclusions:We found an increased risk of stroke associated with anger expression among the A c c e p t e d V e r s i o n 2 participants with low PSS, but not among those with high PSS. Our results suggest that PSS might mitigate the risk of stroke associated with anger.

show abstract

Section: Measurements Of Anger Expression Pss and Stroke Risk Factorsmentioning

confidence: 99%

Impact of Perceived Social Support on the Association Between Anger Expression and the Risk of Stroke: The Circulatory Risk in Communities Study (CIRCS)

Tezuka

Kubota

Ohira

et al. 2023

Journal of Epidemiology

View full text Add to dashboard Cite

show abstract

“…A total of 2478 records were identified through database searching; 1659 duplicate records were removed; 698 records were excluded on the basis of title and abstract and 121 records were reviewed in full. After excluding records which were not the most comprehensive systematic review and meta-analysis (n=53), not especially for purposed exposure (n=4), not the purposed outcomes (n=2), not modifiable factors reported (n=10) and whose full text was not available (n=1), 49 articles, including 70 modifiable factors and approximately 856 801 stroke cases, were included and re-analysed in the present review7 8 10 12 13 16–20 27–65 (figure 1, online supplemental table S3 and S4). The detailed characteristics of included studies are shown in online supplemental table S5.…”

Section: Resultsmentioning

confidence: 99%

“…As shown in online supplemental table S9, the methodological quality of three meta-analyses was low,10 49 56 while others were critically low 7 8 12 13 16–20 27–48 50–55 57–65. The main methodological problems found according to AMSTAR 2 were as follows: meta-analyses did not contain an explicit statement that the review methods were established prior and did not report any significant deviations from the protocol, did not provide a list of excluded studies and justify the exclusions, did not report the sources of funding for each original study and assess the impact of risk of bias in individual studies on the results of the meta-analysis or other evidence synthesis.…”

Section: Resultsmentioning

confidence: 99%

Predictive role of modifiable factors in stroke: an umbrella review

et al. 2022

View full text Add to dashboard Cite

BackgroundA growing number of meta-analyses reviewed the existing associations between modifiable factors and stroke. However, the methodological quality of them and quality of evidence remain to be assessed by validated tools. Thus, this umbrella review was conducted to consolidate evidence from systematic reviews and meta-analyses of cohort studies investigating the association between modifiable factors and incidence of stroke.MethodsPubMed, Web of Science, Embase, Wanfang and China National Knowledge Infrastructure databases for systematic reviews and meta-analyses of cohort studies from inception until March 2021. Assess the methodological quality of systematic reviews 2 was used to evaluate the methodological quality of each included published meta-analysis. Excess significance test was used to investigate whether the observed number of studies (O) with nominally significant results (‘positive’ studies, p<0.05) was larger than the expected number of significant results (E). Statistically significant (p<0.05) associations were rated into five levels (strong, highly suggestive, suggestive, weak and no) using specific criteria. Sensitivity analyses were performed.Results2478 records were identified through database searching. At last, 49 meta-analyses including 70 modifiable factors and approximately 856 801 stroke cases were included in the present review. The methodological quality of three meta-analyses was low, while others were critically low. Evidence of walking pace was strong. High suggestive evidence mainly included total meat, processes meat, chocolate, sodium, obesity, pulse pressure, systolic blood pressure, diastolic blood pressure, sleep duration and smoking. Suggestive evidence mainly included dietary approaches to stop hypertension (DASH) diet, vitamin C, magnesium, depression and particulate matter 2.5. After sensitivity analyses, evidence of DASH diet, magnesium and depression turned to weak. No publication bias existed, except only one study which could be explained by reporting bias.DiscussionDiet with rich macronutrients and micronutrients, healthy dietary patterns and favourable physical, emotional health and environmental management should be promoted to decrease the burden of stroke.PROSPERO registration numberCRD42021249921.

show abstract

“…A recent meta-analysis found no significant association between anger and hostility and stroke risk. 41 However, after the exclusion of male professionals with high SES, anger significantly contributed to an increased stroke risk (hazard ratio, 1.30; 95% CI, 1.06 to 1.59). Thus, anger and hostility may be associated with stroke only in people with low SES.…”

Section: Anger As a Risk Factor For Strokementioning

confidence: 98%

Anger, a Result and Cause of Stroke: A Narrative Review

Choi-Kwon

Kim

2022

J Stroke

View full text Add to dashboard Cite

Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Among them, post-stroke depression is the best known. Although post-stroke anger (PSA) has been studied relatively less, it can be as frequent as depression. Manifestations of PSA range from overt aggressive behaviors (including hitting or hurting others) to becoming irritable, impulsive, hostile, and less tolerable to family members. The possible pathophysiological mechanisms of PSA include neurochemical dysfunction due to brain injury, frustration associated with neurological deficits or unfavorable environments, and genetic predisposition. PSA causes distress in both patients and their caregivers, negatively influences the patient’s quality of life, and increases the burden on caregivers. It can be treated or prevented using various methods, including pharmacological therapies. In addition, anger or hostility may also be a risk or triggering factor for stroke. The hazardous effects of anger may be mediated by other risk factors, including hypertension or diabetes mellitus. The identification of anger as a result or cause of stroke is important because strategic management of anger may help improve the patient’s quality of life or prevent stroke occurrence. In this narrative review, we describe the phenomenology, prevalence, factors or predictors, relevant lesion locations, and pharmacological treatment of PSA. We further describe the current evidence on anger as a risk or triggering factor for stroke.

show abstract

Anger, hostility and risk of stroke: a meta-analysis of cohort studies

Cited by 13 publications

References 38 publications

Impact of Perceived Social Support on the Association Between Anger Expression and the Risk of Stroke: The Circulatory Risk in Communities Study (CIRCS)

Impact of Perceived Social Support on the Association Between Anger Expression and the Risk of Stroke: The Circulatory Risk in Communities Study (CIRCS)

Predictive role of modifiable factors in stroke: an umbrella review

Anger, a Result and Cause of Stroke: A Narrative Review

Contact Info

Product

Resources

About