Worth stressing? Anger may trigger MI episodes

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 - yelling doctor

People with quick tempers have another reason to try to curb their rage. A small study found that stress related to anger had a significant impact on the risk for MI with coronary occlusion.

Thomas Buckley, RN, BSc MN, PhD, of the Royal North Shore Hospital in Sydney, and colleagues enrolled 313 patients with confirmed coronary occlusion between 2006 and 2012. Patients reported anger and stress intensity based on a series of questionnaires for the 48 hours prior to the coronary incident and also provided an assessment of annual levels and frequency of anger. Anger was assessed on a scale from one to five, where one was calm and five was characterized by an enraged state, including behavior that damaged persons or property.

They found 2.2 percent of patients reported anger characterized by tension, clenched fists and readiness “to burst” (level five) or higher within two hours of the MI event. They noted the relative risk of strong levels of anger inciting MI symptoms was 8.5. Anger levels lower than five were not associated with increased risk of MI. They also found using a more refined scale that assessed levels of anger, curiosity and anxiety (State-Trait Personality Inventory) that patients who scored higher (with more stress and more anger) had a relative risk of MI symptoms of 9.5.

The reported anger was associated with arguments with others (42 percent) or family (29 percent), work-related (14 percent), or road-related (14 percent). None of the patients who reported high levels of anger or stress were taking aspirin or beta blockers at the time.

Their findings were relatively consistent with others in this field, but also suggest a difference between anger-related stress-induced cardiomyopathy and Takotsubo cardiomyopathy, another form of emotional stress induced MI. In addition to different emotional/stress triggers, Buckley et al note that anger-related MI is characterized by occlusions in a culprit artery, whereas individuals with Takotsubo cardiomyopathy may have coronary disease and no culprit vessel.

While many of the stressors were interpersonal, work-, or road-related, these findings are also relevant to those who get heavily invested in sports teams, as well.

“Our findings highlight the need to consider strategies to protect individuals most at risk during times of acute anger. Potential preventive approaches may be stress reduction training to limit the responses of anger and anxiety or avoiding activities that usually elicit severe anger, for instance, avoiding an angry confrontation,” they wrote.

The article was published online Feb. 23 in European Heart Journal: Acute Cardiovascular Care.