Anger and stress is a leading cause of heart attacks in younger people, yet one of the most difficult things to prevent. Other risks for heart attack such as drinking, smoking, lack of exercise, or high blood sugar (in diabetes) are easier to prevent. Anger and stress are silent killers because we often don’t know how angry or stressed we are.

Bursts of anger, accompanied by stress, are particularly linked with heart attacks. We often see this portrayed in films and television shows in a dramatic fashion, and it happens to be true.

A study by researchers from the Harvard School of Public Health in March 2014 suggested anger outbursts could raise definitely the risk of heart attack as well as stroke. “Our findings confirm what has been suggested in prior studies and anecdotal evidence, even in films–that episodes of intense anger can act as a trigger for a heart attack,” commented lead author of this latest study Dr. Thomas Buckley, of the Sydney Nursing School at the University of Sydney.

The study, which was published in European Heart Journal: Acute Cardiovascular Care,

Dr. Buckley says episodes of anger or anxiety may lead to increased heart rate, high blood pressure, narrowing of blood vessels and increased clotting, all of which can trigger a heart attack or stroke.

Dr. Buckley and his associates recruited 313 subjects for the study, each of which had previously suffered from a heart attack. Participants in the study were thoroughly questioned about their activities in the 48 hours prior to onset of coronary events. They were asked to rate their levels of anger during these 48 hours on a scale of 1-7, with 1 indicating “calm” and 7 indicating “enraged, out of control, throwing objects, hurting yourselves or others.”

This research revealed that individuals who experienced periods of anger at scale 5 (indicating “very angry, body tense, clenching fists or teeth, ready to burst”) or above in the 48 hours prior to onset of symptoms were 8.5 times more likely to have a heart attack in the 2 hours after an outburst. In addition, the team found that when that anger was accompanied by high levels of anxiety in the 48 hours before symptom onset were 9.5 times more likely to have a heart attack within the following 2 hours.

This study corroborates cases with which I have become acquainted. A few years back one such individual had a heart attack while driving home from the hospital. When I asked him what had happened at the hospital he told me of how he had gotten stressed out and enraged by his experience at the hospital, where he had gone to get an MRI. He said he went in at 10 am and registered at the welcome desk. After signing up for his MRI he waited thirty minutes, growing increasingly angry. He went up to the desk and asked when he would have his MRI, complaining about how long he had been waiting. The woman at the desk, he said, was rude.

“We are have a long line today. We’re doing people as quickly as we can. You just have to wait your turn,” she replied in a testy voice.

“But I had an appointment at 10 am!” he retorted.

“Please sit down and wait your turn.”

His anger and stress mushroomed after this interchange. He waited another thirty minutes and complained again. Again the woman at the desk appeared to him to be rude. Again he walked away angery. He was thinking about what he would say and do, shaking his head and pacing around the room. Finally he was called for his MRI. Afterwards he told his wife he would never come to this hospital again. An hour later, driving home, he had a heart attack and headed back to this hospital. Fortunately his attack was a mild one and he quickly recovered.

The authors of the study pointed to ways of dealing with, and preventing such outbursts of anger. They suggested stress reduction training as well as avoiding situations that might lead to an angry confrontation. They also advocated the use of medications such as aspirin. If an individual feels stressed out and angry, taking an aspirin is a good thing to do because it is a blood thinner that may prevent a clot.

I would add that any kind of psychotherapy can be beneficial to those who are prone to anger and stress, particularly those who are not in touch with their feelings. Psychotherapy helps people to become more aware of how stress and anger affect not only their health but also the way they think and behave. When we’re not in touch with our anger, it is all the more likely to get out of control and cause problems. It is particularly when people become angry because of some frustration about which nothing can be done that coronary events occur.

Coping with life’s frustrations involves understanding how to deal with those kinds of frustrations—that is, accepting that nothing can be done and understanding that getting upset about such things is counterproductive and unhealthy