Data from the INTERHEART study, published in Circulation, supports the theory that you can “give yourself a heart attack” by becoming angry or upset—finding that anger or emotional upset was associated with an increased odds for an acute myocardial infarction. Study author Dr Andrew Smyth (Population Health Research Institute, McMaster University, Canada and the National University of Ireland, Galway) talks to Cardiovascular News about the study.
Prior to your study, what data were available for emotional upset/anger being a trigger for acute myocardial infarction?
The majority of previous data reporting the potential role of emotional upset/anger as a trigger for acute myocardial infarction come from four of anger and three studies of negative emotions. The largest of these studies included 1,623 participants, but five of the seven studies had fewer than 1,000 participants.
What were the key findings of your study?
The key finding of our study is that acute exposure to extremes of physical exertion or anger or emotional upset may be associated with acute myocardial infarction.
What are the potential reasons why emotional upset/anger might trigger a myocardial infarction?
Anger or emotional upset may increase heart rate and blood pressure, leading to altered blood flow; in the heart, this may result in an acute reduction or cessation of blood flow to an area of heart muscle—leading to a myocardial infarction.
Are there some patients who may be particularly susceptible having a myocardial infarction that is triggered by emotional upset/anger?
The association between acute emotional upset/anger and myocardial infarction was similar between age groups (<45, 45-65, >65 years), gender, smoking status (never, former, current), diabetes, hypertension, obesity, previous angina, previous stroke and overall cardiovascular risk (INTERHEART Risk Score). Therefore, we did not find any factors that could identify patients as particularly susceptible. Similarly, we did not find any difference in the association by baseline level of stress (none/some vs. several periods or permanent stress) or history of depression.
What advice would you give to patients at risk of an acute myocardial infarction?
As we did not find any factors that identify people as susceptible to the potential effects of triggers and INTERHEART recruited only patients with first heart attack, we suggest that our findings apply to the general population. Our main message is to highlight the potential risk associated with extremes of anger or emotional upset and we suggest that people should minimise their exposure, where possible. Practically speaking, it may be difficult to predict when an individual will become upset or angry (eg. bereavement); therefore, we also recommend that people develop strategies to reduce the effects of anger, upset or heavy physical exertion.
Is there scope for recommending psychological therapy to help patients avoid becoming emotionally upset/angry?
We suggest that individuals develop a strategy that works for them, to either avoid becoming upset/angry, or to minimise the intensity or duration of anger or upset. For some individuals that may be psychological therapy, for others it may be a specific coping strategy (eg. breathing exercises, meditation etc.), while for others it may be an alternative activity.