Intense Anger Can Increase MI Rates, Study Finds

A newly published study confirms what physicians and patients have suspected for years – that getting very angry is bad for a person’s heart.

The study, published in February in the European Heart Journal: Acute Cardiovascular Care, a journal of the European Society of Cardiology, found that extreme anger can be a trigger for myocardial infarction (MI). The study encourages physicians to look for ways to help patients who are at risk of having an MI to find ways to control stress and anger, along with other risk factors.

Cleveland Clinic cardiologist Curtis Rimmerman, MD, MBA, who was not involved in the study, commented on its importance in an interview with Time magazine.

“This study is very helpful in many ways because it’s validating to what we already know,” Dr. Rimmerman says. “Anger is not what we would call a traditional risk factor because it’s so hard to measure. It highlights the importance of paying attention to a patient’s well-being.”

Study details

The study was an investigation of patients suspected of MI and admitted for primary angioplasty at a hospital in Sydney, Australia, between 2006 and 2012, and assessed by coronary angiography. Of 687 patients initially assessed, 313 were confirmed with occluded coronary blood flow by angiography and were enrolled in the study.

Anger levels were determined by having patients answer a questionnaire that had a seven-point scale, with 1 being “calm,” and 7 being “enraged, out of control, throwing objects, hurting yourself or others.” The study considered a 5 (“very angry, body tense, maybe fists clenched, ready to burst”) as acute anger.

The results showed that patients have an 8.5 times higher risk of MI in the two hours after an acute episode of anger than during the “usual frequency” patterns of anger. It found that the patients’ levels of anger or anxiety preceding the heart attack were significantly higher at hospitalization for MI than at the same time the day before.

In the study’s primary analysis, anger exposures within 2 hours and 2 to 4 hours prior to symptom onset were compared with subjects’ own usual yearly exposures to anger using case-crossover methodology. Anger level of ≥5 was reported by seven (2.2%) participants within 2 hours of the MI. Compared with usual frequency, the relative risk of onset of MI symptoms occurring within 2 hour of anger level ≥5 was 8.5 (95% confidence interval 4.1-17.6). Anger level

Arguments with family members or others topped the list of events that prompted the subjects’ anger-triggered MIs, followed by anger arising from work or while driving.

Use for prevention

The authors concluded that more study, including on ways for physicians to help their patients handle their stress and anger better, could “provide insight into prevention of MI during acute emotional episodes.”

The investigators also said the findings coincide with an “increased acceptance of the role of psychological factors, both acute and chronic, in the onset of acute MI, sudden cardiac death and stroke,” and “are consistent with previous reports in other populations.” Unlike most other studies, however, this one could confirm angiographically that the subjects had indeed suffered an MI.