Rage Attacks Can Trigger Heart Attacks

A new study from Harvard School of Public Health concluded that outbursts of anger increase the risk of heart attacks, stroke, and other cardiovascular problems—especially in the two hours immediately following the incident.

The March 2014 study is the first to systematically evaluate previous research linking extreme emotion and all cardiovascular outcomes. The findings of the study titled, “Outbursts of Anger as a Trigger of Acute Cardiovascular Events: a Systematic Review and Meta-Analysis” were published in the European Heart Journal.

The research was led by Murray Mittleman (MD, DrPH) who is director of the Cardiovascular Epidemiology Research Unit at Harvard Medical School. The researchers looked at a broad range of studies carried out between January 1966 and June 2013 that examined links between anger and a wide range of cardiovascular outcomes.

One of the researchers, Elizabeth Mostofsky (MPh, ScD), an instructor at the Harvard School of Public Health and a postdoctoral fellow in the cardiovascular epidemiological unit at Beth Israel Deaconess Medical Center said: "Although the risk of experiencing an acute cardiovascular event with any single outburst of anger is relatively low, the risk can accumulate for people with frequent episodes of anger.”

The researchers advise that these new findings are particularly important for people who have higher cardiovascular risks due to other underlying risk factors or those who have already had a heart attack, stroke or diabetes.

Mostofsky said, “a person without many risk factors for cardiovascular disease, who has only one episode of anger per month, has a very small additional risk, but a person with multiple risk factors or a history of heart attack or stroke, and who is frequently angry, has a much higher absolute excess risk accumulated over time."

The authors believe that there are several potential mechanisms linking anger outbursts and cardiovascular problems. The researchers said, "Psychological stress has been shown to increase heart rate and blood pressure, and vascular resistance. Changes in blood flow can cause blood clots and may stimulate inflammatory responses.”

Rage Attacks = Heart Attacks

Among people who were frequently angry, five episodes of anger a day could result in around 158 extra heart attacks per 10,000 people with a low cardiovascular risk per year and around 657 extra heart attacks per 10,000 annually among those with a high cardiovascular risk.

Two hours immediately after an angry outburst, a person's risk of a heart attack—myocardial infarction (MI) or acute coronary syndrome (ACS)—increased nearly fivefold. The risk of stroke increased more than threefold. The risk of ventricular arrhythmia also increased compared to other times when they were not angry.

Mittleman advises, "It is important to recognize that outbursts of anger are associated with higher risk of heart attacks, stroke and arrhythmia. If clinicians ask patients about their usual levels of anger and find that it is relatively high, they may want to consider suggesting either psychosocial or pharmacological interventions.”

Conclusion: How Do You Heal a Hostile Heart?

The researchers conclude, “Given the lessons we have learned from trying to treat depression after MI, treating anger in isolation is unlikely to be impactful. Instead, a broader and more comprehensive approach to treating acute and chronic mental stress, and its associated psychological stressors, is likely to be needed to heal a hostile heart.”

I have written a wide range of Psychology Today blogs on the power of mindfulness training, meditation, yoga and other lifestyle choices to create equanimity and peace of mind. Clearly, there are pharmaceuticals that can help combat emotional states that lead to outbursts of anger, but these often have negative side effects and may prove ineffective in the long run.

A rigorous cardio workout, kick boxing session or pounding out some weights are always an effective way to let off steam. Through daily habits of mindset and behavior many studies have shown that it is possible to remedy psychological stressors linked to rage attacks and a hostile heart without losing your cool. 

If you’d like to read more on this topic, check out my Psychology Today blog posts:

• "4 Simple Ways to Replace Hostility With Equanimity”
• "Yoga Has Potent Health Benefits”
• "The Neuroscience of Social Pain"
• “Cortisol: Why "The Stress Hormone" Is Public Enemy No. 1"
• "Optimism Stabilizes Cortisol Levels and Lowers Stress"
• "Can Meditation Make Someone More Compassionate?"
• “The Neuroscience of Empathy”
• "The Neurobiology of Grace Under Pressure"
• "Do 'Mirror Neurons' Help Create Social Understanding?"
• “Compassion Can Be Trained”
• ”How Does Meditation Reduce Anxiety At a Neural Level?”
• "Neuroscientists Confirm That Our Loved Ones Become Ourselves"

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