Birthday Surprises: Strokes, Heart Attacks and TIAs

TORONTO, Aug. 1 -- Perhaps patients in their 70s should be advised to play it cool on their birthdays. The excitement surrounding the event increases the risk of stroke and heart attacks, according to researchers here.

Data from hospital admissions over a two-year period revealed that vascular events -- strokes, acute myocardial infarctions or transient ischemic attacks -- are 27% more likely on a birthday than on other days of the year, reported Gustavo Saposnik, M.D., of the University of Toronto, and colleagues, online in Neurology.

The daily observed number of vascular events during the birthday was higher than the expected number of daily visits for stroke (87 versus 67; P=0.009), TIA (58 versus 44; P=0.02) and acute myocardial infarctions (97 versus 80; P=0.027), they wrote.

There were 24,315 emergency department admissions for acute stroke, 16,088 TIA admissions and 29,090 acute myocardial infarctions admissions from April 2002 to March 2004 in the province of Ontario.

Multivariate logistic regression revealed that birthday vascular events were more likely in patients with a history of hypertension (OR=1.88; 95% CI 1.09 to 3.24). They found no increased risk for asthma exacerbations, appendicitis, or head trauma on birthdays.

The mean age of patients who had birthday strokes was 72.3 versus 73.9 for patients whose strokes did not occur on their birthdays. For TIAs, the mean age of patients who had birthday attacks was 70.7 versus 72.5 for any day, events and for acute myocardial infarctions the mean ages were 68.1 versus 67.9.

The authors hypothesize that a birthday "may represent an acute psychosocial stressor for some individuals, as it may induce several emotional, physical and mental changes."

The authors noted that the study was limited by its reliance on an administrative clinical database, which could include errors including the proper recording of a patient's birth date or correct diagnostic code.

And in any event, birthdays are not an avoidable risk factor.

Nonetheless, the authors contended that knowing that birthdays pose an increased risk "is the first step for implementing preventive strategies."

For example, they suggested that safe birthday celebrations should avoid "cold temperatures, excess physical exertion, and salt and alcohol consumption."