Study shows nearly fivefold increased risk for heart attack after angry outburst

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 getting anger in check – a nearly fivefold increase in risk for heart attack 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," 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 risk factors."

In the study published 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 other time. 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 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 (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 times.

"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."