Does anger raise the risk of a heart attack?


Flying into a rage can substantially increase the risk of a heart attack within a 2 hour period, compared with just feeling angry, a study has demonstrated.

Australian researchers say the findings appear to confirm what has been suggested in other studies, as well as anecdotal evidence about anger triggering heart attacks.

The report, published in the ‘European Heart Journal Acute Cardiovascular Care’, highlights a need “to consider strategies to protect individuals most at risk during times of acute anger”, say the authors.

However, British heart experts say the number of patients involved in the study is too small to draw any firm conclusions about a link between anger and heart attack risk.

7-point anger scale

The study focused on 313 patients in Sydney, Australia who had been admitted to hospital because of heart attacks.

The patients filled out questionnaires in which they assessed their state of mind during the 48 hours before experiencing symptoms according to a 7-point scale, with 1 defined as ‘calm’ and 7 as ‘enraged, out of control, throwing objects, hurting yourself or others’.

For the purposes of this study, the threshold of acute anger was defined as level 5: ‘very angry, body tense, maybe fists clenched, ready to burst’.

When the researchers analysed the data they found that 7 of the confirmed heart attack cases (2.2%) had reached anger of at least level 5 within 2 hours of developing symptoms.

Also, one participant had reached anger level 5 within 4 hours of having a heart attack, while anger level 4, defined as ‘moderately angry, so hassled it shows in your voice’, was reported by 2 participants within 2 hours of their heart attacks and by 3 participants within 4 hours.

8-fold increase in risk

After taking into account the usual anger patterns experienced by the participants, the researchers say that the relative risk of heart attack within 2 hours of feeling intense anger is 8 and a half times higher than among those who experienced normal patterns of anger.

Additionally, high levels of anxiety were associated with a 9 and a half times increased risk of triggering a heart attack in the 2 hours after the anxiety episode when compared with anxiety levels the previous day, they say.

The authors suggest that findings such as these coincide with an “increased acceptance of the role of psychological factors, both acute and chronic, in the onset of acute MI [myocardial infarction, or heart attack], sudden cardiac death and stroke.”

‘The danger is real’

Dr Thomas Buckley, a senior lecturer and researcher from the University of Sydney, says in a statement: “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 explains that the increased risk of a heart attack 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 says that anger management should be part of the standard treatment for any patient assessed to be at risk of periods of intense anger.

The authors say their research differs from most other studies because they used angiograms to ensure that all the volunteers had experienced heart attacks.

‘More research needed’

Commenting on the study in a statement, Doireann Maddock, senior cardiac nurse at the British Heart Foundation, says: “Although these findings are interesting, the number of people affected was very small.

“More research is needed to explore their suggested link of intense anger as a trigger for a heart attack.

“The way you cope with stress can reduce angry outbursts and help you move on from high pressure scenarios.

““Doing regular physical activity can act as a stress buster. You could also learn relaxation techniques for managing stress.

“If you’re worried about how you’re coping with stress or are experiencing frequent anger outbursts have a chat with your GP


web news – culled from




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