Bursts of Anger Tied to Heart Troubles

Heart attack and stroke risk increase tied to outbursts of anger

(RxWiki News) Calming down to keep from bursting out in anger might not just be good for your relationships — it might be better for your heart, according to a new review.

This new review looked at the risk of cardiovascular events immediately following an outburst of anger.

The review revealed that in the two hours after an outburst of anger, people were almost five times more likely to have a heart attack than at other times.

"Speak to a mental health professional about ways to control your anger."

According to the authors of this review, led by Elizabeth Mostofsky, MPH, ScD, of the Beth Israel Deaconess Medical Center at Harvard Medical School in Boston, short-term mental stress is tied to an immediate physical response in the body, and might be also tied to cardiovascular events like heart attack or stroke.

To explore the connection between brief episodes or outbursts of anger and cardiovascular events, Dr. Mostofsky and colleagues looked for studies from January 1966 to June 2013 that included data on this topic.

This research team identified nine studies in total, four of which focused on heart attacks, two on ischemic stroke, one on aneurysm (a bulge in an artery that can rupture or burst) and one on arrhythmia (problems with the rate of heartbeat).

After analyzing data from these studies, Dr. Mostofsky and team found a 4.74 times higher risk of a heart attack in the 2 hours following an outburst of anger as compared to other times.

These researchers also found a 3.62 times higher rate of stroke in the 2 hours following an outburst of anger and a 6.30 times higher rate of a ruptured brain aneurysm in the hour following an outburst of anger.

In one study that looked at 277 people with implanted defibrillators to help regulate arrhythmia problems, the participants were 1.83 times more likely to experience a shock of their defibrillator in response to an abnormal heart rate in the 15 minutes after an angry outburst compared to other times.

In a press release from Beth Israel Deaconess Medical Center, Murray Mittleman, MD, DrPH, one of the review's co-authors, explained that while the cardiovascular event risk increased following an outburst in all the reviewed studies, the potential added risk from anger is most concerning for those already predisposed to heart troubles.

“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,” said Dr. Mittleman. “However, we should be concerned about the occurrence of angry outbursts with our higher risk patients and our patients who have frequent outbursts of anger.”

dailyRx News spoke with Jordan Safirstein, MD, FACC, FSCAI, assistant director of the Cardiac Catheterization Laboratories at Morristown Medical Center and Director of Transradial Intervention, about this study.

"Firstly, it is important to recognize the design of this study was retrospective — meaning they looked at older studies, pooled all the data and re-analyzed them to answer a different question. This is not uncommon, but it is also not an ideal way to answer a question, particularly when many of the studies included were small in sample size and heterogeneous in the way they were designed," Dr. Safirstein told dailyRx News.

"Despite its limitations, Dr. Mostofsky's conclusion was that frequent angry outbursts are connected to higher rates of stroke and heart attack, particularly in those that also have multiple risk factors for cardiovascular disease (i.e. hypertension, high cholesterol, diabetes, and smoking). This is a reasonable conclusion as episodes of anger have shown increase in catecholamine levels, increase in the work performed by the heart and even reversible changes in blood flow, similar to that seen in heavy exertional activities," Dr. Safirstein said.

"However, the question remains, what to do about our anger issues? One might theorize that if the impact of anger is significant on our healthy hearts then efforts to remain calm and relax would show long-term improvements in outcomes. We know from numerous reports that lifestyle changes like daily exercise, yoga and meditation can not only produce de-stressing results but also improve our cardiovascular health. Only long-term, prospective analyses could definitively answer this question, but according to Dr. Mostofsky's results and logical thinking, it's a good bet that if you control your anger with healthy outlets, you will have a better chance of having a healthy heart," Dr. Safirstein said.

More research is needed to confirm these findings and further explore the relationship between cardiovascular events and outbursts of anger.

This study was published online March 3 by the European Heart Journal. No conflicts of interest were reported.

Review Date: 
March 4, 2014