Anecdotal evidence and some studies suggest that intense anger can trigger a heart attack. This seems to have been confirmed in a new study published today in the European Heart Journal: Acute Cardiovascular Care, on patients in whom myocardial infarction (heart attack) was confirmed to have occurred by angiogram. In this study, being very angry conferred an 8.5 fold higher risk of having a heart attack within two hours, while extreme anxiety also increased risk by 9.5 fold.



The difference between this study and many previous publications is that coronary occlusion was confirmed in the subjects by angiogram. The study was carried out in Royal North Shore Hospital in Sydney, Australia by a research team based in the hospital and Sydney Nursing School and Sydney Medical School. Self-reported levels of anger in the previous 48 hours were recorded in 313 patients with confirmed acute coronary occlusion. The levels of anger two hours and 2-4 hours prior to the heart attack were compared to the participant’s usual yearly levels of anger. Anger was self-assessed on a scale of 1-7, with level 1 being defined as "calm", level 5 being defined as ‘very angry, body tense, clenching fists or teeth’ and level 7 defined as "enraged, out of control, throwing objects, hurting yourself or others".



The results of the study showed that seven (2.2%) of the participants reported an anger level of ≥5 within two hours of onset of symptoms. When the usual frequencies of anger were determined, it was calculated that these levels of anger conferred an 8.5 fold higher relative risk of myocardial infarction. Anxiety levels were also assessed using the State–Trait Personality Inventory. Results showed that anxiety scores >75th percentile on this test conferred a 2-fold higher risk of myocardial infarction, while a score above the 90th percentile conferred a 9.5 fold higher risk. The most common reasons for the high levels of anger were arguments with family members or others, work conflicts or incidents while driving.



Lead author Dr Thomas Buckley of the University of Sydney and Royal North Shore Hospital explained: "While the absolute risk of any one anger episode triggering a heart attack is low, our data demonstrates that the danger is real and still there." He further explained that the increased risk following intense anger or anxiety is "most likely the result of increased heart rate and blood pressure, tightening of blood vessels and increased clotting, all associated with triggering of heart attacks".



Dr Buckley suggested that tendency to become angry or anxious should be taken into account in the clinical management of individuals with heart disease and in strategies for heart disease prevention. He concluded: "Potential preventive approaches may be stress reduction training to limit the responses of anger and anxiety, or avoiding activities that usually prompt such intense reactions. And for those at very high risk, one could potentially consider protective medication therapy at the time of or just prior to an episode, a strategy we have shown to be feasible in other studies. Minimising other risk factors, such as hypertension or smoking, would also lower risk".