Wary! These 6 behaviors increase the risk of stroke in the short term, including drinking Coke...

The researchers investigated whether nine triggers were associated with stroke in young adults: alcohol consumption, smoking, caffeinated coffee, coffee-containing cola, strenuous exercise, sexual activity, use of illicit drugs (cocaine, heroin, ecstasy, etc.
), fever, and flu-like illness
.
The risk period of the corresponding trigger is set, that is, the short-term risk
of stroke is investigated for a period of time after the trigger is triggered.

The risk period for drinking, smoking, coffee, cola and strenuous exercise is 1 hour, the risk period for sex is 2 hours, the risk period for illegal drug use is 4 hours, and the risk period for fever and flu-like illness is 24 hours
.

The study, which is part of the ODYSSEY study, a multicenter prospective cohort study in the Netherlands, completed a questionnaire on exposure to nine potential triggers during the risk period in patients aged 18-49 years who first developed ischemic stroke or hemorrhagic stroke (ICH) in 17 participating centers in the Netherlands, and 1146 patients completed the questionnaire (1043 ischemic stroke patients, 103 ICH patients, mean age 44.
0 years, male 52.
6%), after statistical analysis, the data are as follows
.

01

Table 1.
The relative risk of each trigger for all types of stroke

Data show that for all types of stroke (including ischemic stroke and ICH):

(1) the risk of stroke increased to 200% within 1 hour after drinking cola (RR 2.
0, 95% CI 1.
5-2.
8);

(2) increased stroke risk to 260% within 1 hour after strenuous physical exercise (RR 2.
6, 95% CI 2.
2-3.
0);

(3) increased stroke risk to 240% within 2 hours after sex (RR 2.
4, 95% CI 1.
6-3.
5);

(4) increased stroke risk to 280% within 4 hours of illicit drug use (RR 2.
8, 95% CI 1.
7-4.
9);

(5) increased stroke risk to 1410% within 24 hours after fever (RR 14.
1, 95% CI 10.
5-31.
2);

(6) increased stroke risk to 1390% within 24 hours after influenza-like illness (RR 13.
9, 95% CI 8.
9-21.
9);

(7) no short-term stroke risk was found after exposure to alcohol or coffee;

(8) no smoking was found to be a stroke trigger;

(9) The risk of stroke increased to 160% (RR 1.
6, 95% CI 1.
3-1.
9) within 1 hour after strenuous physical exercise in regular exercisers, and the risk of stroke increased to 1020% (RR 10.
2, 95% CI 7.
9-13.
1) within 1 hour after strenuous physical exercise in those who exercised regularly, which was significantly higher than that of regular
。

02

Table 2.
Relative risk of triggers for ischemic stroke and ICH

Strenuous physical activity and sexual activity increase the risk of ischemic stroke and ICH during dangerous periods, while drinking cola, using illegal drugs, fever or flu-like illness only increase the risk of ischemic stroke, namely:

(1) The risk of ischemic stroke increased to 250% and the risk of ICH increased to 360% within 1 hour after strenuous physical exercise;

(2) The risk of ischemic stroke increased to 190% and the risk of ICH increased to 560% within 2 hours after sex;

(3) The risk of ischemic stroke increased to 190% within 1 hour after drinking cola;

(5) the risk of ischemic stroke increased to 270% within 4 hours of using illegal drugs;

(6) The risk of ischemic stroke increased to 1510% within 24 hours after fever;

(7) The risk of ischemic stroke increased to 1520%
within 24 hours after influenza-like illness.

03

The researchers conducted further investigation and analysis
based on the internationally recognized classification of ischemic stroke etiology, the TOAST type.

Table 3.
The relative risk of ischaemic stroke by trigger for TOAST classification

The results show:

(1) strenuous physical activity (RR 3.
2, 95% CI 2.
3-4.
3), use of illicit drugs (RR 4.
0, 95% CI 1.
7-9.
7), fever (RR 7.
9, 95% CI 2.
5-25.
5), and influenza-like illness (RR 10.
4, 95% CI 3.
9 to 28.
1) is a trigger for cryptogenic stroke;

(2) fever (RR 18.
8, 95% CI 5.
8-61.
0) and influenza-like illness (RR 24.
8, 95% CI 10.
8-56.
9) were triggers for large vessel atherosclerosis and possibly atherosclerotic thrombotic stroke;

(3) No trigger for ischemic stroke caused by small vessel disease was found;

(4) For cardiogenic ischaemic stroke, strenuous physical activity (RR 2.
9, 95% CI 2.
0-4.
2) and fever (RR 29.
1, 95% CI 12.
3-68.
4), influenza-like illness (RR 22.
2, 95% CI 8.
8-55.
8).
is the trigger;

(5) For other identified causes of ischemic stroke, drink cola (RR 4.
9, 95% CI 2.
6-9.
3), strenuous physical exercise (RR 3.
4, 95% CI 2.
4-4.
9), and fever (RR 13.
1, 95% CI 3.
4-51.
0).
and influenza-like illness (RR 15.
5, 95% CI 5.
6 to 42.
9) as triggers;

(6) For multi-cause ischaemic stroke, vigorous physical activity (RR 2.
8, 95% CI 1.
6-5.
2) and fever (RR 48.
4, 95% CI 10.
2-230.
3) were triggers
.

04

Table 4.
The relative risk of each trigger for ICH of different etiologies

The data results show:

(1) In the 'macrovascular' group, heavy exercise (RR 19.
2, 95% CI 3.
8-97.
7) and extreme exercise (RR 83.
2, 95% CI 5.
2-1336.
3) were triggers
.

(2) For the "other causes" group, drinking cola, strenuous exercise, vigorous exercise, extreme exercise, and sexual activity appeared to increase the risk of
post-exposure ICH.

(3) Due to the small sample size, the "macrovascular" group could not calculate whether drinking cola, using illegal drugs, fever, etc.
were triggers, and whether influenza-like illness in the "macrovascular" group and the "other causes" group was not included in the calculation
.

Researchers believe there are several possible biological explanations
for how triggers increase the risk of stroke.

First, triggers such as caffeine intake, use of certain types of drugs, sexual activity, and strenuous physical activity can temporarily increase
blood pressure.
Increased blood pressure may lead to increased shear stress on the walls of arteries and may lead to destruction of the surface of endothelial cells, which may increase the risk of
thromboocclusion.

After exercise, the body is in a state of dehydration, and the state of blood hypercoagulability may also lead to thrombosis
in the cerebral blood vessels.
Second, a sudden increase in blood pressure can cause the walls of blood vessels to rupture, leading to intracerebral hemorrhage
.
In addition, some drug types are known to cause vasospasm without bleeding, which can also lead to stroke
.

Second, fever and influenza-like illness may contribute to an increased risk of stroke because it can lead to systemic inflammation with endothelial dysfunction, platelet activation, and increased
aggregation.

Third, coffee has not been identified as a trigger for any type of stroke in younger populations
, compared to previous studies in older populations.
One possible explanation may be that a sudden spike in blood pressure affects older and younger adults differently, with older people more likely to suffer from long-term high blood pressure, atherosclerosis, and reduced
elasticity of blood vessel walls.

Finally, consistent with previous literature, the researchers did not find smoking to be a trigger, or even negative relative risk, which could be related
to a variety of causes.
The researchers speculate that regular, heavy coffee drinking and very frequent smoking habits may lead to tolerance to the hemodynamic effects of caffeine and nicotine, which may be one of the reasons why smoking is not a
trigger.

When triggers translate into risk factors

Further research is needed

Overall, fever and flu-like illness were the strongest triggers of youth stroke, followed by coke drinking, strenuous exercise, sexual activity and the use of illicit drugs
.
Future research should focus on how and when triggers translate into risk factors, can unravel the causes of cryptogenic stroke and other types of stroke in young people with stroke, and provide more personalized prevention
for potential young stroke patients.