NEW YORK (Reuters Health) - People with heart disease might want to take a careful look at how they handle their feelings of anger. A new study found that heart disease patients who suppressed their anger had nearly triple the risk of having a heart attack or dying over the next 5 to 10 years.

But this doesn’t mean that angry outbursts are a better way to handle these feelings, Dr. Johan Denollet of Tilburg University in The Netherlands told Reuters Health. People tend to either vent angry feelings or hold them inside, “but I think it’s important for (people) to find a midway solution to resolve these angry feelings -- but in a more constructive way, a more adaptive way,” Denollet said.

Anger can strangle blood flow in the heart and lead to abnormal heart rhythms, and has been linked to an increased risk of heart disease. There’s also evidence that suppressing anger can be harmful to the heart. In the current study, the researchers investigated the interplay among “Type D” personality, anger, anger suppression, and outcomes in heart disease patients.

People with Type D personalities are prone to suffer from anger and other negative emotions, and find it difficult to express themselves in social situations. “This is the perfect mixture so to speak to render people more liable to chronic forms of stress and tension, which may have a negative impact,” Denollet said. Type D’s represent about one in five people in the general population, but as many as one in three heart disease patients, the researcher noted.

In the study, 644 patients with coronary artery disease were followed for an average of about six years, during which time 20 percent had a “major adverse cardiac event,” meaning they died, had a heart attack, or underwent surgery to restore blood flow to the heart. Ten percent of the entire group died or had a heart attack during the study. Twenty-seven percent of the study participants had Type D personalities.

Anger and anger suppression were related to the risk of a major adverse event, but this relationship disappeared once the researchers took factors like blood pressure and heart disease severity into account. But a significant relationship remained between suppressed anger and the risk of heart attack or death even after the researchers adjusted for these and other factors.

While 4 percent of the patients who didn’t have Type D personalities had high levels of suppressed anger, nearly 20 percent of the Type D personality patients did, the researchers found. The personality type also quadrupled the risk of having a heart attack or dying during follow-up.

The findings don’t mean that people with Type D personalities or people who have a tough time expressing their anger are doomed to be unhealthy, Denollet noted. “Anger is one of the emotions that (tells) us something is not going the way we would like it to go,” the researcher said. People should be aware of their angry feelings and figure out where they’re coming from; “it’s important to take next steps and try to do something about the situation,” Denollet told Reuters Health.

For some people, according to Denollet, finding a way to speak up for themselves and discuss what’s angering them with other people in a “sociable, nice way” will be enough; for others, professional help such as assertiveness training and social skills training may be warranted.

SOURCE: American Journal of Cardiology, online April 12, 2010.