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July 25, 2006; 67 (2) Articles

Does a birthday predispose to vascular events?

Gustavo Saposnik, Akerke Baibergenova, Jason Dang, Vladimir Hachinski
First published May 25, 2006, DOI: https://doi.org/10.1212/01.wnl.0000217915.06544.aa
Gustavo Saposnik
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Akerke Baibergenova
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Jason Dang
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Vladimir Hachinski
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Does a birthday predispose to vascular events?
Gustavo Saposnik, Akerke Baibergenova, Jason Dang, Vladimir Hachinski
Neurology Jul 2006, 67 (2) 300-304; DOI: 10.1212/01.wnl.0000217915.06544.aa

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Abstract

Objective: To examine the influence of birthdays on the onset and course of vascular events such as stroke, TIA, and acute myocardial infarction (AMI).

Methods: This population-based study included all emergency department (ED) admissions due to ischemic stroke, TIA, or AMI from April 2002 to March 2004 in Ontario, Canada. All cases were identified through the National Ambulatory Care Reporting System. Calculations of daily and weekly numbers of events were centered on the patient’s birthday and the week of the birthday. Statistical analyses include binomial tests and logistic regression.

Results: During the study period, there were 24,315 ED admissions with acute stroke, 16,088 with TIAs, and 29,090 with AMI. The observed number of vascular events during the birthday was higher than the expected daily number of visits for stroke (87 vs 67; p = 0.009), TIA (58 vs 44; p = 0.02), and AMI (97 vs 80; p = 0.027) but not for selected control conditions (asthma, appendicitis, head trauma). Vascular events were more likely to occur on birthday (242 vs 191; odds ratio [OR] = 1.27). No significant differences were observed during the birthday week for any of the conditions. Multivariate logistic regression showed that birthday vascular events were more likely to occur in patients with a history of hypertension (OR = 1.88; 95% CI 1.09 to 3.24). Sensitivity analyses with alternative definitions of birthday week did not alter the results.

Conclusions: Stress associated with birthdays may trigger vascular events in patients with predisposing conditions.

The influence of individual, environmental, and social factors on the onset of vascular diseases is not well understood. Mental stress may trigger vascular events by different mechanisms such as impairing vasomotor response, heart rate variability, and promoting thrombosis.1 A few studies have examined the risk of vascular events during stressful life events or special days such as Christmas, New Year, sporting events, or earthquakes.2–6 A birthday, being a potential psychosocial stressor, may trigger vascular events by inducing autonomic dysfunction such as ventricular arrhythmias and sudden death in patients with predisposing conditions.7 Despite these considerations, we found no previous studies that examined whether a birthday affects the onset/course of vascular events such as stroke, TIA, and acute myocardial infarction (AMI).

We hypothesized that 1) the incidence of stroke, TIA, and AMI increases around birthdays and 2) this phenomenon is specific for vascular diseases but not for other control conditions. As the majority of patients with stroke, TIA, AMI, and control conditions (acute appendicitis, asthma, head trauma) seek immediate medical attention arriving to the emergency department (ED), we focused on the number of ED admissions due to these conditions.

In the current article, we seek to provide separate measures of this effect and to analyze associated factors with vascular events occurring on birthdays. The awareness of unexplored triggers may help improve the understanding of epidemiologic and pathophysiologic mechanisms of vascular diseases and consequently identify preventive strategies.

Methods.

Data source.

We identified patients admitted to the ED from the National Ambulatory Care Reporting System (NACRS) managed by the Canadian Institute for Health Information. NACRS receives data directly from 188 ambulatory health care facilities in Ontario and contains demographic, diagnostic, and procedural information on all ambulatory visits within the province. The study period covered 2 years from April 1, 2002, to March 31, 2004. Admissions due to stroke, TIA, AMI, and control conditions (asthma, appendicitis, and head trauma) were identified through patients’ principal diagnosis recorded using the International Classification of Diseases (10th rev.; ICD-10) codes. The following ICD-10 codes were used: stroke (I63, I64), AMI (I21, I22), TIA (G45), acute appendicitis (K35), asthma (J45), and head trauma (S06). Individuals who were born or visited the ED on February 29 were excluded from the analysis. The following NACRS variables were used for the study: the date of ED visit, patient’s birth date, age, gender, comorbidities, and visit disposition (hospital admission, discharge home, and death).

According to the reabstraction study conducted after the implementation of ICD-10 by the Canadian Institute for Health Information for quality assurance, diagnosis in the abstract coincides with diagnosis in the chart in 92% of stroke and AMI cases. Nonmedical data elements in this study had agreement rates ranging from 96 to 100%.8

Statistical analysis.

Calculation of daily and weekly number of events was centered on the patient’s birthday. All events were grouped according to the daily and weekly proximity to the birthday. The “birthday week” was defined as a 7-day interval for which the birthday is the midpoint (this definition includes 3 days prior to the birthday, the birthday, and 3 days after the birthday). The “birthday” group included ED visits that took place on the patient’s birthday. Similarly, the “birthday week” group included all events that occurred during the “birthday week.” As patients had birthdays on different days throughout a year, all seasonal effects were diluted. Our analytical strategy included several steps. First, we calculated the expected ED visits due to stroke, TIA, and AMI on the basis of a random distribution (daily average = total number of events/365 days and weekly average = total number of events/52 weeks). The observed proportion of birthday events was compared with the expected proportion of daily (1/365 = 0.0027397) and weekly (1/52 = 0.0192307) events to determine the significance.

As it was expected that the number of vascular events around birthdays is higher than the observed number in a routine day or week, a one-tailed p value of <0.05 was considered significant. We applied the same strategy to control conditions to determine if the effect of the birthday, as a psychosocial stressor, is specific to vascular conditions. The control conditions were selected based on the degree of urgency in seeking medical care similarly to vascular diseases. These conditions included head trauma, acute asthmatic crisis, and acute appendicitis.

Second, multivariate logistic regression was used to determine if age, gender, and vascular risk factors (i.e., hypertension, diabetes, ischemic heart disease, etc.) were associated with the risk of having vascular events on the birthday.

Finally, additional sensitivity analyses were performed using alternative time intervals including 6 days prior to and after the birthday as well as 14 days prior to and after the birthday. Statistical analyses were performed using STATA (version 8.0; Stata Corp. LP, TX).

Results.

During the 2-year period, there were 24,315 admissions due to acute stroke, 16,088 admissions due to TIAs, and 29,090 admissions due to AMI. This corresponds to an expected 67 daily visits for stroke, 44 daily visits for TIAs, and 80 daily visits for AMI. The mean age was 74 years for stroke patients, 72.5 years for patients with TIAs, and 68 years for patients with AMI (table 1). Minor differences in some percentages comparing birthday vs non-birthday events (gender, weekend visits, season distribution) can be explained by small number of observations in the birthday group.

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Table 1 Population characteristics

Table 2 shows the results of binomial tests for “birthday” and “non-birthday” groups as well as for the “birthday week” and “non-birthday week” groups for each vascular event. In addition, patients with acute appendicitis, asthma, and head trauma usually presenting to the EDs were analyzed as controls to verify if birthday influences conditions other than vascular events. For all three vascular conditions, there was a significant difference between the number of visits that occurred on patient birthdays vs the expected daily number of visits. In contrast, no significant differences were found in any of the control conditions. Overall, visits due to vascular events were more likely to occur on birthdays than the expected per day (p = 0.0002). Furthermore, spikes on ED visits for stroke, TIA, and AMI were higher than the peaks associated with other special days in the calendar such as Christmas, New Year, statutory days, or holidays (figures 1 through 3).

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Table 2 Distribution of events according to birthday

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Figure 1. Distribution of stroke during the year and birthday stroke according to the fiscal year (April 1 to March 31). The dotted line indicates the expected number of strokes per day. The solid line indicates the daily average per week during the study period. Relevant calendar days and statutory holidays are shown. The observed number of strokes occurring on birthdays is shown at the right upper corner to be compared with the daily average and other peaks occurring on special days.

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Figure 2. Distribution of TIAs during the year and birthday TIAs according to the fiscal year (April 1 to March 31). The dotted line indicates the expected number of TIAs per day. The solid line indicates the daily average per week during the study period. Relevant calendar days and statutory holidays are shown. The observed number of TIAs occurring on birthdays is shown at the right upper corner to be compared with the daily average and other peaks occurring on special days.

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Figure 3. Distribution of acute myocardial infarction (AMI) during the year and birthday AMIs according to the fiscal year (April 1 to March 31). The dotted line indicates the expected number of AMIs per day. The solid line indicates the daily average per week during the study period. Relevant calendar days and statutory holidays are shown. The observed number of AMIs occurring on birthdays is shown at the right upper corner to be compared with the daily average and other peaks occurring on special days.

When birthday week was analyzed, no significant difference emerged between the number of events observed and the number of events expected for all vascular and control conditions. A marginal effect was found when combining all vascular events (table 2).

There was no significant difference between “birthday” and “non-birthday” groups in distribution of gender and age. Birthday events occurring at “milestone” ages (e.g., 40, 50, 60, etc.) were not different from the ones occurring at other ages (p = 0.22). Although birthday events were more common in men (OR = 1.25; 95% CI 0.96 to 1.64) than in women, this gender difference was not significant. The interaction between gender and age (tested both as a continuous and a categorical variable) was not significant. Hypertension was found to be an independent predictor for birthday vascular events in the logistic regression analysis (OR = 1.88; 95% CI = 1.09 to 3.24; table 3). No differences were observed in the visit disposition (hospital admission, discharge home, mortality) between birthdays and non-birthday events for stroke (p = 0.55), TIA (p = 0.59), AMI (p = 0.23), and for all combined vascular events (p = 0.38). Analyses with alternative definitions of birthday week did not substantially change the results (data are not shown).

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Table 3 Logistic regression analysis for all combined birthday events

Discussion.

In this large population-based study, we found a consistent and significant increase in the number of ED visits due to acute stroke, TIA, and myocardial infarction on patient birthdays. The likelihood of having a vascular event on a birthday is 27% higher than the expected daily average. However, the observed number of events occurring during the birthday week did not differ from the expected ones. In contrast, there was no increase in the number of ED visits on a birthday for control conditions, suggesting that the potential effect of a birthday is specific to vascular events. Age was not associated with vascular events that occurred on birthdays. A nonsignificant increase of birthday events was observed in men. Birthday peaks for each of the three vascular conditions were higher than peaks associated with other special day in the calendar, such as Christmas, New Year, statutory holidays, or holidays.

Stressful life events can trigger vascular events such as acute stroke, myocardial infarction, and sudden cardiac death. Victims of natural disasters such as earthquakes, terrorist attacks, and other conditions of extreme stress are at the highest risk of a vascular event.2,4,9

A birthday may represent an acute psychosocial stressor for some individuals, as it may induce several emotional, physical, and mental changes.1,10 The effects of atherosclerosis on the vasomotor response to mental stress have been better studied in ischemic heart disease than cerebrovascular disease. Mental stress produces a significant increase in heart rate and blood pressure that may lead to increased myocardial oxygen demand and plaque disruption. Whereas coronary arteries of normal patients dilate during mental stress, impaired dilatation and even vasoconstriction have been noted in atherosclerotic arteries.11,12 These changes may develop acutely. For example, in a cross-over study including patients with coronary disease and exercise-induced ischemia, the risk of myocardial ischemia doubled in the subsequent hour following negative emotions (feelings of tension, frustration, and sadness).13

Although not all studies have shown consistent findings, mental stress enhances platelet aggregation secondary to sympathetic activity in plasma caused by platelet-derived growth factors.14–16 A compensatory increased fibrinolytic activity occurs after acute stress, but a diminished fibrinolytic response owing to endothelial dysfunction may lead to prothrombic imbalance. Such changes may trigger ischemia or infarction in patients with vascular risk factors and atherosclerosis.17 Other autonomic changes are mediated by the brain. For example, the insular cortex may have a relevant role in mediating cardiac arrhythmias and vascular events by modifying heart rate variability, prolonging the QT segment on the EKG, increasing norepinephrine levels and finally the arterial blood pressure.12,18–20 Not only are cardiogenic and neurogenic mechanisms involved, but interestingly, a defect in the KChIP2 gene confers a marked genetic susceptibility to ventricular tachycardia and vascular death in humans.21

Birthdays are not avoidable, and situations provoking stress often arise unexpectedly. Although some benefit may be achieved through interrupting the link between the stressor and the cardiovascular event by pharmacologic and nonpharmacologic therapies, it is difficult to predict the occurrence of a vascular event. However, the knowledge that birthdays are associated with an increase in vascular events (stroke, TIA, and AMI) is the first step for implementing preventive strategies. For example, the avoidance of exposure to cold temperatures, excess physical exertion, and salt and alcohol consumption can be emphasized in those individuals with known risk factors around their birthday. Alcohol intake can exacerbate the autonomic dysfunction, depress cardiac contractility, and increase cardiac arrhythmias causing the “holiday heart syndrome.”22 In addition, reminder strategies may help improve the adherence to medications during birthdays. Aspirin and β-blockers may be warranted in selected patients, particularly during times of distress.23,24

Limitations of this study arise from the reliance on an administrative clinical database. The possibility of errors in recording the patient’s birthday or diagnostic codes cannot be excluded. On the other hand, there is no reason to believe that potential errors would be distributed in a way that would bias the results of the study. As the study included ED visits, patients not presenting to the ED were missed. However, missed events are not likely to represent a high proportion of cases as the vascular conditions, as well as the selected control diseases, are serious enough and often life-threatening conditions that force patients to seek immediate medical care.

Acknowledgment

The authors thank Greg Webster for his support and the Canadian Institute for Health Information (CIHI) for providing the data.

Footnotes

  • This article was previously published in electronic format as an Expedited E-Pub on May 25, 2006, at www.neurology.org.

    Supported in part by a grant of the Heart Stroke Foundation of Canada (HSFC) and Canadian Institute for Health Research (CIHR) given to Dr. Gustavo Saposnik. The grant was obtained based on competitive applications following publication of grant advertisements. The investigators acted as the sponsors of the study. Neither the HSFC nor the CIHR had input on the design, access to the data, analyses, interpretation, or publication of the study. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Disclosure: The authors report no conflicts of interest.

    Received November 30, 2005. Accepted in final form February 23, 2006.

References

  1. 1.↵
    Stalnikowicz R, Tsafrir A. Acute psychosocial stress and cardiovascular events. Am J Emerg Med 2002;20:488–491.
  2. 2.↵
    Witte DR, Bots ML, Hoes AW, Grobbee DE. Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study. Br Med J 2000;321:1552–1554.
    OpenUrlAbstract/FREE Full Text
  3. 3.
    Carroll D, Ebrahim S, Tilling K, Macleod J, Smith GD. Admissions for myocardial infarction and World Cup football: database survey. Br Med J 2002;325:1439–1442.
    OpenUrlAbstract/FREE Full Text
  4. 4.
    Brown DL. Disparate effects of the 1989 Loma Prieta and 1994 Northridge earthquakes on hospital admissions for acute myocardial infarction: importance of superimposition of triggers. Am Heart J 1999;137:830–836.
    OpenUrlCrossRefPubMed
  5. 5.
    Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996;334:413–419.
    OpenUrlCrossRefPubMed
  6. 6.
    Phillips DP, Jarvinen JR, Abramson IS, Phillips RR. Cardiac mortality is higher around Christmas and New Year’s than at any other time: the holidays as a risk factor for death. Circulation 2004;110:3781–3788.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    Hemingway H, Malik M, Marmot M. Social and psychosocial influences on sudden cardiac death, ventricular arrhythmia and cardiac autonomic function. Eur Heart J 2001;22:1082–1101.
    OpenUrlFREE Full Text
  8. 8.↵
    Data Quality of the Discharge Abstract Database Following the First-Year Implementation of ICD-10-CA/CCI. Final report: Canadian Institute for Health Information, September 2004.
  9. 9.
    Allegra JR, Mostashari F, Rothman J, Milano P, Cochrane DG. Cardiac events in New Jersey after the September 11, 2001, terrorist attack. J Urban Health 2005;82:358–363.
    OpenUrlPubMed
  10. 10.
    Klein HH. [Stress and myocardial infarction]. Herz 2001;26:360–364.
    OpenUrlPubMed
  11. 11.↵
    Yeung AC, Vekshtein VI, Krantz DS, et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991;325:1551–1556.
    OpenUrlCrossRefPubMed
  12. 12.↵
    Cheung RT, Hachinski VC, Cechetto DF. Cardiovascular response to stress after middle cerebral artery occlusion in rats. Brain Res 1997;747:181–188.
    OpenUrlCrossRefPubMed
  13. 13.↵
    Gullette EC, Blumenthal JA, Babyak M, et al. Effects of mental stress on myocardial ischemia during daily life. JAMA 1997;277:1521–1526.
    OpenUrlCrossRefPubMed
  14. 14.↵
    Falk E. Why do plaques rupture? Circulation 1992;86(suppl 6):III30–III42.
    OpenUrlPubMed
  15. 15.
    Bacon SL, Ring C, Hee FL, et al. Hemodynamic, hemostatic, and endothelial reactions to psychological and physical stress in coronary artery disease patients. Biol Psychol 2005;71:162–170.
    OpenUrlPubMed
  16. 16.
    Mischler K, Fischer JE, Zgraggen L, Kudielka BM, Preckel D, von Kanel R. The effect of repeated acute mental stress on habituation and recovery responses in hemoconcentration and blood cells in healthy men. Life Sci 2005;77:1166–1179.
    OpenUrlCrossRefPubMed
  17. 17.↵
    Mittleman MA, Maclure M, Nachnani M, Sherwood JB, Muller JE. Educational attainment, anger, and the risk of triggering myocardial infarction onset. The Determinants of Myocardial Infarction Onset Study Investigators. Arch Intern Med 1997;157:769–775.
    OpenUrlCrossRefPubMed
  18. 18.
    Korpelainen JT, Sotaniemi KA, Makikallio A, Huikuri HV, Myllyla VV. Dynamic behavior of heart rate in ischemic stroke. Stroke 1999;30:1008–1013.
    OpenUrlAbstract/FREE Full Text
  19. 19.
    Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Arch Neurol 2000;57:1685–1688.
    OpenUrlCrossRefPubMed
  20. 20.
    Naver HK, Blomstrand C, Wallin BG. Reduced heart rate variability after right-sided stroke. Stroke 1996;27:247–251.
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    Ackerman MJ, Tester DJ, Jones GS, Will ML, Burrow CR, Curran ME. Ethnic differences in cardiac potassium channel variants: implications for genetic susceptibility to sudden cardiac death and genetic testing for congenital long QT syndrome. Mayo Clin Proc 2003;78:1479–1487.
    OpenUrlCrossRefPubMed
  22. 22.↵
    Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ. Arrhythmias and the “holiday heart”: alcohol-associated cardiac rhythm disorders. Am Heart J 1978;95:555–562.
    OpenUrlCrossRefPubMed
  23. 23.↵
    Mittleman MA, Maclure M, Sherwood JB, et al. Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators. Circulation 1995;92:1720–1725.
    OpenUrlAbstract/FREE Full Text
  24. 24.
    Verrier RL, Hagestad EL, Lown B. Delayed myocardial ischemia induced by anger. Circulation 1987;75:249–254.
    OpenUrlAbstract/FREE Full Text

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