Anger and Heart Attacks

By Jane Farrell

For some people, anger could literally be a killer.

A new study has found that there’s a nearly fivefold increase in heart attack risk in the two hours following an outburst.

“There has been a lot of research on anger; we already know it can be unhealthy, but we wanted to quantify the risk, not just for heart attack, but for other potentially lethal cardiovascular events as well,” said lead author Elizabeth Mostofsky, MPH, ScD, a post-doctoral fellow in the cardiovascular epidemiological unit at Beth Israel Deaconess Medical Center.

 “The hope is this might help patients think about how they manage anger in their everyday lives and prompt physicians to discuss medications and psychosocial supports with their patients for whom anger is an issue, especially patients with known cardiovascular risk factors.”

The findings were published in the European Heart Journal.

For the analysis, the investigators reviewed studies published between 1966 and 2013. Ultimately, they focused on nine case crossover studies where patients who had experienced cardiovascular events answered questions about anger. The participants were asked about their level of anger just before to the cardiovascular event compared with other times, using terms like very angry, furious or enraged.

The study results showed that the risk of heart attack or acute coronary syndrome – the symptoms like chest pain, shortness of breath or sweating related to a blocked artery – was 4.7 times higher in the two hours following an angry outburst than at any other time. And the risk for stroke caused by a blocked artery in the brain was 3.6 times higher than at other times. One study indicated a 6.3 fold increased risk for brain aneurysm in the hour following an outburst of anger compared with other times.

Mostofsky and colleagues also found that patients with implanted cardiac defibrillators (ICD) were nearly twice as likely to experience an abnormal heart rate requiring a shock from the ICD in the 15 minutes following an angry outburst than at other times.

“It’s important to bear in mind that while these results show a significantly higher risk of a cardiovascular event associated with an angry outburst, the overall risk for people without other risk factors like smoking or high blood pressure is relatively small, about one extra heart attack per 10,000 people each year,” said senior author Murray Mittleman, MD, DrPH, a physician in the CardioVascular Institute at BIDMC. “However, the risk is cumulative, so the more angry outbursts, the higher the risk.”