Researchers found a nearly fivefold increase in risk of myocardial infarction in the two hours following outbursts of anger.
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, lead author Elizabeth Mostofsky, MPH, ScD, a post-doctoral fellow in the cardiovascular epidemiological unit at Beth Israel Deaconess Medical Center and an instructor at the Harvard School of Public Health in Boston, said in a news release.
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.
In the study, published March 3 on the website of the European Heart Journal, Mostofsky and colleagues performed a systematic review of studies published between 1966 and 2013. They identified nine case crossover studies in which patients who had experienced cardiovascular events answered questions about anger.
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 MI or acute coronary syndrome was 4.7 times higher in the two hours following an angry outburst than at any other time, and the risk for ischemic stroke was 3.6 times higher. 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 other times.
Mostofsky and colleagues also examined two studies that looked at arrhythmia and anger. Analysis of these studies showed that patients with implanted cardiac defibrillators 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 as at other times.
Its 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, senior author Murray Mittleman, MD, DrPH, a physician in the CardioVascular Institute at BIDMC, associate professor of medicine at Harvard Medical School and director of BIDMCs cardiovascular epidemiological research program, said in the news release.
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.
Although medications and other interventions might lower the frequency of angry outbursts or the risk associated with anger, more research including clinical trials are needed to identify which drugs or behavioral therapies will be most effective, Mostofsky said.