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Stressful life events as triggers of ischemic stroke: a case-crossover study

Authors

  • Vincent Guiraud,

    1. Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie et Unité Neurovasculaire, Hôpital Sainte-Anne, Paris, France
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  • Emmanuel Touzé,

    1. Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie et Unité Neurovasculaire, Hôpital Sainte-Anne, Paris, France
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  • Frédéric Rouillon,

    1. Université Paris Descartes, Sorbonne Paris Cité, INSERM U 675, Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, Paris, France
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  • Olivier Godefroy,

    1. Université d'Amiens, EA 4559, Service de Neurologie, Hôpital d'Amiens-Picardie, Amiens, France
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  • Jean-Louis Mas

    Corresponding author
    • Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie et Unité Neurovasculaire, Hôpital Sainte-Anne, Paris, France
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  • Conflict of interest: None declared.

Correspondence: Jean-Louis Mas*, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Service de Neurologie et Unité Neurovasculaire, Hôpital Sainte-Anne, 1 rue Cabanis, Paris 75014, France.

E-mail: jl.mas@ch-sainte-anne.fr

Abstract

Background

Acute stressors, such as stressful life events, might trigger ischemic stroke.

Aims

Our objective was to investigate the association between life events exposure and ischemic stroke onset.

Methods

Consecutive patients were interviewed about life events exposure (e.g. bereavement) using the Interview for Recent Life Events. Using a case-crossover approach, life events exposure within one month of stroke onset (hazard period) was compared with exposure during five control periods of one month preceding the hazard period. Similarly, life events exposure within one week of stroke onset was compared with exposure during three control periods of one week. Odds ratios and 95% confidence intervals were calculated using conditional logistic regression.

Results

Two hundred forty-seven patients were interviewed within a median time of five days (interquartile range 3–7). Life events belonging to bereavement, health, and other categories accounted for half of life events. Over the six-month period, 187 patients were exposed to ≥1 life events. Patients were exposed to ≥1 life events more often during the first month preceding stroke onset than during the five control periods (odds ratio = 2·96; 95% confidence interval, 2·19–4·00). Over the four-week period, 97 patients were exposed to ≥1 life events. Patients were exposed to ≥1 life events more often during the first week preceding stroke onset than during the three control periods (odds ratio = 2·10; 1·40–3·17).

Conclusions

Recent life events exposure is associated with an increased risk of ischemic stroke.

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