Burst of Anger Greatly Increases Risk of Heart
Attack, Stroke and Brain Aneurysm for Many
Overall risk for people without other risk factors
like smoking or high blood pressure is relatively small
March 4, 2014 Warning people they are going to
have a heart attack if they dont calm down is, perhaps, better advice
than you have imagined. New research says the risk of a heart attack in
the two hours following an outburst of anger is five times greater than
when we are calm. And, the risk of a stroke jumps almost four times.
Call it what you will getting red in the face,
hot under the collar, losing your cool, blowing your top we all
experience anger. And while we know that anger is a normal, sometimes
even beneficial emotion, we're also aware of the often harmful
connection between anger and health. New research from Beth Israel
Deaconess Medical shows an even more compelling reason to think about
keeping anger in check.
"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," says lead author Elizabeth Mostofsky,
MPH, ScD, a post-doctoral fellow in the cardiovascular epidemiological
unit at BIDMC and an instructor at the Harvard School of Public Health.
"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
In the study published Tuesday in the European
Heart Journal, Mostofsky and colleagues performed a systematic
review of studies published between 1966 and 2013.
They identified nine case crossover studies where
patients who had experienced cardiovascular events answered questions
about anger. They were asked about their level of anger immediately
prior to the cardiovascular event with anger at other times, using terms
like very angry, furious or enraged.
The researchers found that despite differences
between the studies, there was "consistent evidence of a higher risk of
cardiovascular events immediately following outbursts of anger."
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
And, the risk for stroke caused by a blocked artery
in the brain was 3.6 times higher than at other times. One of the
studies included in the review indicated a 6.3 fold increased risk for
brain aneurysm in the hour following an outburst of anger compared with
Two studies of arrhythmia and anger
Mostofsky and colleagues also examined two studies
that looked at arrhythmia and anger. Analysis of these studies showed
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
"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," says senior author Murray Mittleman, MD, DrPH, a physician in
the CardioVascular Institute at Beth Israel Deaconess Medical Center, an
Associate Professor of Medicine at Harvard Medical School and director
of BIDMC's cardiovascular epidemiological research program.
"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."
While it's possible that medications and other
interventions that may lower the frequency of angry outbursts or the
risk associated with anger, Mostofsky says "more research including
clinical trials are needed to identify which drugs or behavioral
therapies will be most effective."
This study was supported by grants T32-HL098048 and
F32-HL120505 from the National Heart, Lung, and Blood Institute at the
National Institutes of Health.
Elizabeth Anne Penner from the Department of
Internal Medicine, New York Presbyterian Hospital and Weill Cornell
Medical Center is a co-author on the study.
Beth Israel Deaconess Medical Center is a patient
care, teaching and research affiliate of Harvard Medical School, and
currently ranks third in National Institutes of Health funding among
independent hospitals nationwide.
The BIDMC health care team includes Beth Israel
Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth
Israel Deaconess Hospital-Plymouth, Anna Jaques Hospital, Cambridge
Health Alliance, Lawrence General Hospital, Signature Health Care,
Commonwealth Hematology-Oncology, Beth Israel Deaconess HealthCare,
Community Care Alliance, and Atrius Health. BIDMC is also clinically
affiliated with the Joslin Diabetes Center and Hebrew Senior Life and is
a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the
official hospital of the Boston Red Sox. For more information, visit
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