When @#%!! Threatens the Heart

We all have times when bad temper gets the best of us. But letting anger escalate to an outpouring of rage can unleash more than just harsh words. The risk of heart attack or stroke rises dramatically after outbursts of anger, according to researchers from Beth Israel Deaconess Medical Center.

In fact, you are five times more likely to have a heart attack in the two hours after an angry outburst according to the study, which was published in European Heart Journal on March 3, 2014. Risk for stroke is 3.6 times higher after a fit of rage.

"After you experience anger, the body moves into the 'fight or flight' response," explains senior study author Murray Mittleman, MD, DrPH, a physician in the CardioVascular Institute at BIDMC and Director of its Cardiovascular Epidemiological Research Program. "Your adrenaline and heart rate increase, blood vessels constrict and blood pressure rises. Stress hormones actually impact blood platelets, which makes blood more prone to form clots. This response made sense in past evolution, since the body was preparing for potential injury. But today, this barrage of stimulators to the cardiovascular system cause mental distress and potential physical harm."

BIDMC researchers were among the first to look at whether angry outbursts could trigger heart attacks, according to Mittleman. Since then, multiple studies have examined the connection between rage and heart events like stroke or heart attacks.

"Our recent study looked at the totality of the past research and found remarkably consistent results," he says.

Mittleman and his colleagues reviewed multiple studies published between 1966 and 2013. They identified nine studies that researched patients who had heart events and their level of anger immediately prior to a cardiovascular event. While the studies differed, they all shared evidence of a jump in the risk for heart events just after outbursts of anger.

While these results show a spike in heart risk after an episode of fury, "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," explains Mittleman.

But if you are prone to frequent attacks of anger, the chance for heart trouble rises.

"The risk is cumulative, so the more angry outbursts, the higher the risk," he cautions, "which means we should be concerned about the occurrence of angry outbursts with our higher risk patients as well as our patients who have frequent outbursts of anger."

What emerges from this cumulative research is the need to identify actions that prevent heart events due to distress.

"Are there behavioral interventions to lessen stress response when provoked, or medications that help break the link with emotional states and arrhythmia? We need more research to determine if specific behavioral interventions will help," says Mittleman. "But we do recommend that people, heart patients in particular, find a better way to deal with or respond to stress."

Mittleman provides the following advice to help lower risk for heart events and stress: