Stock volatility may trigger the onset of acute coronary syndrome: A nationwide case-crossover analysis
-
GRAPHICAL ABSTRACT
DownLoad:
Full size image
-
PUBLIC SUMMARY
-
Both stock rise and fall increase the risk of acute coronary syndrome onset.
Effects occur on the concurrent day of stock volatility and last for three days.
The increased risk is significantly higher for unstable angina and ST-segment-elevation myocardial infarction.
Heart care and psychological support are vital during stock market fluctuations.
-
-
ABSTRACT
Stock volatility, an adverse psychological stressor, has been linked to cardiovascular mortality or hospitalization. However, no studies had quantified the risk of acute coronary syndrome (ACS) onset from stock market fluctuation. Using the time-stratified case-crossover design, which could control for the potential confounding from time-invariant, we conducted the analysis based on a nationwide registry comprising of 2,113,728 ACS patients in China from January, 2015 to December, 2021. We obtained daily returns (%) of three main stock indexes in Chinese Mainland, and matched the case and control days of ACS onset on hourly level. The data were analyzed using conditional logistic regression models. The associations between daily stock returns and ACS onset were U-shaped with stock rise and fall both increasing the risk of ACS onset. The excess risks associated with each 1%-decrease of daily stock returns for Shanghai, Shenzhen and ChiNext index were 0.96% (95%CI: 0.40,1.51), 0.65% (95%CI: 0.27,1.03) and 0.87% (95%CI: 0.52,1.21) at the concurrent day, respectively; and a 1%-increase of daily stock returns was associated with 1.06% (95%CI: 0.61,1.52), 0.45% (95%CI: 0.11,0.80) and 0.17% (95%CI: -0.08,0.41) increases of ACS onset, respectively. Thereafter, most of the associations gradually attenuated, disappeared after 3 days. The associations were significant for unstable angina and ST-segment-elevation myocardial infarction, but not for non-ST-segment-elevation myocardial infarction. This nationwide study provides novel and robust evidence that both stock rise and fall could increase the risk of ACS onset, highlighting the importance of heart care and psychological support during fluctuations of stock market. -
-
REFERENCES
[1] Eisen, A., Giugliano, R.P., and Braunwald, E. (2016). Updates on acute coronary syndrome: A review. JAMA Cardiol. 1: 718−730. DOI: 10.1001/jamacardio.2016.2049. [2] Long, Z., Xu, Y., Liu, W., et al. (2022). Mortality trend of heart diseases in China, 2013–2020. Cardiology Plus 7: 111−117. DOI: 10.1097/CP9.0000000000000019. [3] Li, L., Zhou, X., Jin, Z., et al. (2022). Clinical characteristics and in-hospital management strategies in patients with acute coronary syndrome: Results from 2,096 accredited Chest Pain Centers in China from 2016 to 2021. Cardiology Plus 7: 192−199. DOI: 10.1097/CP9.0000000000000032. [4] Everson-Rose, S.A., and Lewis, T.T. (2005). Psychosocial factors and cardiovascular diseases. Annu. Rev. Public Health 26: 469−500. DOI: 10.1146/annurev.publhealth.26.021304.144542. [5] Ramachandruni, S., Handberg, E., and Sheps, D.S. (2004). Acute and chronic psychological stress in coronary disease. Curr. Opin. Cardiol. 19: 494−499. DOI: 10.1097/01.hco.0000132321.24004.25. [6] Ma, W.J., Chen, H.L., Jiang, L.L., et al. (2011). Stock volatility as a risk factor for coronary heart disease death. Eur. Heart J. 32: 1006−1011. DOI: 10.1093/eurheartj/ehq495. [7] Lin, H.L., Zhang, Y.H., Xu, Y.J., et al. (2013). Large daily stock variation is associated with cardiovascular mortality in two cities of Guangdong, China. Plos One 8: e68417. DOI: 10.1371/journal.pone.0068417. [8] Chen, C.C., Chen, C.S., Liu, T.C., et al. (2012). Stock or stroke? Stock market movement and stroke incidence in Taiwan. Soc. Sci. Med. 75: 1974−1980. DOI: 10.1016/j.socscimed.2012.07.008. [9] Fiuzat, M., Shaw, L.K., Thomas, L., et al. (2010). United States stock market performance and acute myocardial infarction rates in 2008-2009 (from the Duke Databank for Cardiovascular Disease). Am. J. Cardiol. 106: 1545−1549. DOI: 10.1016/j.amjcard.2010.07.027. [10] Li, W., Chen, J., He, X., et al. (2023). Stock volatility and hospital admissions for cardiovascular disease: Results from the National Insurance Claims for Epidemiological Research (NICER) study. Lancet Reg. Health West Pac. 31: 100595. DOI: 10.1016/j.lanwpc.2022.100595. [11] Chen, R.J., Jiang, Y.X., Hu, J.L., et al. (2022). Hourly air pollutants and acute coronary syndrome onset in 1.29 million patients. Circulation 145 : 1749-1760. DOI: 10.1161/CIRCULATIONAHA.121.057179. [12] Zhou, M.G., Wang, H.D., Zeng, X.Y., et al. (2019). Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 394: 1145−1158. DOI: 10.1016/S0140-6736(19)30427-1. [13] Xiang, D.-C., Jin, Y.-Z., Fang, W.-Y., et al. (2021). The national chest pain centers program: Monitoring and improving quality of care for patients with acute chest pain in China. Cardiology Plus 6: 187−197. DOI: 10.4103/2470-7511.327239. [14] Milojevic, A., Wilkinson, P., Armstrong, B., et al. (2014). Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case-crossover analysis of the MINAP database, hospital admissions and mortality. Heart 100: 1093−1098. DOI: 10.1136/heartjnl-2013-304963. [15] Thygesen, K., Alpert, J.S., Jaffe, A.S., et al. (2018). Fourth universal definition of myocardial infarction (2018). Circulation 138: e618−e651. DOI: 10.1161/CIR.0000000000000617. [16] Amsterdam, E.A., Wenger, N.K., Brindis, R.G., et al. (2014). 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 130: e344−426. DOI: 10.1161/CIR.0000000000000133. [17] Chinese Society of Cardiology of Chinese Medical Association, and Editorial Board of Chinese Journal of Cardiology. (2019). 2019 Chinese Society of Cardiology (CSC) guidelines for the diagnosis and management of patients with ST-segment elevation myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi 47: 766−783. DOI: 10.3760/cma.j.issn.0253-3758.2019.10.003. [18] Chinese Society of Cardiology of Chinese Medical Association, and Editorial Board of Chinese Journal of Cardiology. (2017). Guideline and consensus for the management of patients with non-ST-elevation acute coronary syndrome(2016). Zhonghua Xin Xue Guan Bing Za Zhi 45: 359−376. DOI: 10.3760/cma.j.issn.0253-3758.2017.05.003. [19] Maclure, M., and Mittleman, M.A. (2000). Should we use a case-crossover design? Annu. Rev. Public Health 21: 193−221. DOI: 10.1146/annurev.publhealth.21.1.193. [20] Chen, R., Jiang, Y., Hu, J., et al. (2022). Hourly air pollutants and acute coronary syndrome onset in 1.29 million patients. Circulation 145 : 1749-1760. DOI: 10.1161/CIRCULATIONAHA.121.057179. [21] Zhu, X., Chen, R., Zhang, Y., et al. (2023). Low ambient temperature increases the risk and burden of atrial fibrillation episodes: A nationwide case-crossover study in 322 Chinese cities. Sci. Total Environ. 880: 163351. DOI: 10.1016/j.scitotenv.2023.163351. [22] Li, F.D., Zhong, J.M., He, F., et al. (2022). Stock market fluctuation and stroke incidence: A time series study in Eastern China. Soc. Sci. Med. 296: 114757. DOI: 10.1016/j.socscimed.2022.114757. [23] Altman, D.G., and Bland, J.M. (2003). Interaction revisited: The difference between two estimates. BMJ 326: 219. DOI: 10.1136/bmj.326.7382.219. [24] Liu, Y., Pan, J., Fan, C., et al. (2021). Short-term exposure to ambient air pollution and mortality from myocardial infarction. J. Am. Coll. Cardiol. 77: 271−281. DOI: 10.1016/j.jacc.2020.11.033. [25] Schwartz, B.G., Pezzullo, J.C., McDonald, S.A., et al. (2012). How the 2008 stock market crash and seasons affect total and cardiac deaths in Los Angeles County. Am. J. Cardiol. 109: 1445−1448. DOI: 10.1016/j.amjcard.2012.01.354. [26] Wong, W.H.S., Lee, J.C.Y., Ho, F.K.W., et al. (2017). Stock market fluctuations and self-harm among children and adolescents in Hong Kong. Int. J. Environ. Res. Public Health 14: 623. DOI: 10.3390/ijerph14060623. [27] Lokken, P.R., Wellenius, G.A., Coull, B.A., et al. (2009). Air pollution and risk of stroke underestimation of effect due to misclassification of time of event onset. Epidemiology 20: 137−142. DOI: 10.1097/EDE.0b013e31818ef34a. [28] Kopp, M.S., Skrabski, A., Szekely, A., et al. (2007). Chronic stress and social changes - Socioeconomic determination of chronic stress. Ann. Ny. Acad. Sci. 1113: 325−338. DOI: 10.1196/annals.1391.006. [29] Kroth, J., Thompson, L., Jackson, J., et al. (2002). Dream characteristics of stock brokers after a major market downturn. Psychol. Rep. 90: 1097−1100. DOI: 10.2466/pr0.2002.90.3c.1097. [30] Mohacsy, I., and Lefer, H. (2007). Money and sentiment: A psychodynamic approach to behavioral finance. J. Am. Acad. Psychoanal. Dyn. Psychiatry 35: 455−475. DOI: 10.1521/jaap.2007.35.3.455. [31] Hinterdobler, J., Schott, S., Jin, H., et al. (2021). Acute mental stress drives vascular inflammation and promotes plaque destabilization in mouse atherosclerosis. Eur. Heart J. 42: 4077−4088. DOI: 10.1093/eurheartj/ehab371. [32] Wilbert-Lampen, U., Leistner, D., Greven, S., et al. (2008). Cardiovascular events during World Cup Soccer. N. Engl. J. Med. 358: 475−483. DOI: 10.1056/NEJMoa0707427. [33] Fang, C., Yin, Y.W., Jiang, S.Q., et al. (2022). Increased vulnerability and distinct layered phenotype at culprit and nonculprit lesions in STEMI versus NSTEMI. JACC Cardiovasc. Imag. 15: 672−681. DOI: 10.1016/j.jcmg.2021.07.022. [34] Tsutsumi, A., Kayaba, K., Kario, K., et al. (2009). Prospective study on occupational stress and risk of stroke. Arch. Intern. Med. 169: 56−61. DOI: 10.1001/archinternmed.2008.503. [35] Lian, H., Ding, X., Zhang, H., et al. (2020). Short-term effect of stock volatility and cardiovascular mortality: A systematic review and meta-analysis. Ann. Transl. Med. 8: 1317. DOI: 10.21037/atm-20-6557. [36] Ramanathan, R., Gram, J.B., Sidelmann, J.J., et al. (2019). Sex difference in fibrin clot lysability: Association with coronary plaque composition. Thromb. Res. 174: 129−136. DOI: 10.1016/j.thromres.2018.12.020. [37] Wang, X., Wang, S., and Kindzierski, W. (2019). Eliminating systematic bias from case-crossover designs. Stat. Methods Med. Res. 28: 3100−3111. DOI: 10.1177/0962280218797145. [38] Janes, H., Sheppard, L., and Lumley, T. (2005). Case-crossover analyses of air pollution exposure data: Referent selection strategies and their implications for bias. Epidemiology 16: 717−726. DOI: 10.1097/01.ede.0000181315.18836.9d. -
ABOUT THIS ARTICLE
Cite this article:
Zhu X., Chen R., Liu F., et al., (2023). Stock volatility may trigger the onset of acute coronary syndrome: A nationwide case-crossover analysis. The Innovation Medicine 1(3), 100038. https://doi.org/10.59717/j.xinn-med.2023.100038
Welcome!
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center's (CCC) Marketplace website at marketplace.copyright.com.
Figures(3)
Tables(2)
Article Metrics
Relative Articles
Cited by
Export File
Citation
Zhu X., Chen R., Liu F., et al., (2023). Stock volatility may trigger the onset of acute coronary syndrome: A nationwide case-crossover analysis. The Innovation Medicine 1(3), 100038. https://doi.org/10.59717/j.xinn-med.2023.100038
Format
Content
-
Figure 1.
Flowchart for the inclusion and exclusion of acute coronary syndrome (ACS) patients.
-
Figure 2.
Cumulative exposure-response curves for the associations of ACS onset with the stock returns of Shanghai, Shenzhen and ChiNext index over lag 0 d
-
Figure 3.
Percent change (%) and 95% confidence intervals in the risk of ACS onset associated with 1%-point change of daily stock returns of Shanghai, Shenzhen and ChiNext index over different lag days [(A): Decrease of index; (B): Increase of index]
