Angry Hearts More Likely to Break

Three new studies offer proof that emotions affect the heart

WEDNESDAY, April 24, 2002 (HealthDayNews) -- Sit back, relax and let your anger go.

What sounds like a mantra from a new-age guru is actually advice from some of the world's leading cardiology experts -- researchers who this week offered important new evidence that stress, anger and fatigue can significantly damage your heart.

In the first of two reports presented today at the American Heart Association's Asia Pacific Scientific Forum in Honolulu, researchers from the University of North Carolina at Chapel Hill offered a look at how long-term anger and fatigue together form a type of stress that can significantly hurt your heart.

"[This] psychological stress adds up, [and] the accumulation can have long-term damaging effects on the heart… [resulting] in a breakdown in the body's ability to adapt and a resulting heart attack," says study presenter Janice Williams, currently an epidemiologist at the Centers for Disease Control and Prevention.

Williams' study found the stress created by a combination of anger and exhaustion could build in the body over time, dramatically increasing the risk of heart attack and sudden cardiac death.

For cardiologist Dr. Dan Fisher, the results are reminiscent of earlier studies showing that Type A personalities -- those who are hard-driven and often prone to anger -- are at increased risk for heart disease.

"I think this study builds on evidence that has been coming in for some time now showing that anger and stress have similar effects on the heart -- and both can cause a variety of physiological events that eventually can increase the risk of heart attack," says Fisher, a cardiologist at New York University Medical Center.

For the research, Williams looked at a racially mixed sample of middle-aged men and women involved in the Atherosclerosis Risk in Communities Study, a large, prospective study of cardiovascular risk factors in four U.S. communities.

At the start of the study, the participants took a series of psychological tests designed to determine if their personality was anger-prone, and if they were suffering from fatigue indicative of stress.

From 1990 to 1998, researchers tracked the 12,453 men and women, looking for incidence of heart attack and sudden cardiac death.

They found that those who scored highest on either an anger or fatigue test were 42 percent more likely to have a heart attack or die of sudden cardiac death than those who scored lowest. In addition, the men and women who scored high on both tests were 69 percent more likely to suffer a heart attack or sudden cardiac death.

The results remained true, says Williams, even after adjusting for such established risk factors for heart disease as high blood pressure, smoking, diabetes and high cholesterol.

"Findings from [our] current study support previous work in this area, and suggest psychological stress may have long-term damaging effects on the heart," Williams says.

Those findings are supported by another study just published in this week's Annals of Internal Medicine. In that work, researchers from Johns Hopkins School of Medicine in Baltimore found quick-tempered young men have triple the risk of developing premature heart disease and early heart attack, even when there was no family history of heart disease.

The finding came from a long-term study of 1,000 men who became medical students between 1948 and 1964. It revealed that those identified via psychological testing as having anger-prone personalities early on in their careers ended up far more likely to have heart attacks later in life.

In the 36-year follow-up report, researchers found that by age 76, 35 percent of the angry men had developed cardiovascular disease, with an average onset at age 56. One hundred and forty-five had developed heart disease; 94 had a heart attack; 59 had a stroke.

Eight percent of the group -- 77 men -- had premature cardiovascular disease beginning as early as age 49. Thirty-four of them ended up with a heart attack, and 13 had premature strokes.

According to study author Dr. Patricia Chang, anger causes a stress-related release of hormones that constrict blood vessels, which in turn places extra stress on the heart. This causes the entire cardiovascular system to work harder, she says, and increases the risk of heart disease and, eventually, heart attack.

In a third study, also presented today at the American Heart Association conference, researchers from the University of Minnesota/Minneapolis Heart Institute Foundation in Minneapolis found women may be the most susceptible to the effects of psychological stress on the heart, while men are more sensitive to physical stress.

The study, which looked at 122 men and women who had a heart attack, concluded the physiological mechanism that causes sudden cardiac death may work on different biological pathways, and be based on gender.

This seems particularly true in regard to adrenaline, a hormone linked to the onset of heart attack. For men, the researchers say, physical stress appears to prompt the sudden and dramatic increases in adrenaline linked to heart attacks, while for women, emotional stress can do it.

Although 40 percent of the women studied said they experienced psychological stressors before their heart attack, only 5 percent said they experienced physical exertion. Conversely, 40 percent of the men reported experiencing physical stress before their heart attack, while only 16 percent reported experiencing emotional stress.

What To Do

To learn more about how stress and anger affects your heart health, visit

To find out more about women and heart disease, visit the American Heart Association. For information about all risk factors for heart disease, click here.

SOURCES: Janice Williams, Ph.D., M.P.H., epidemiologist, Centers for Disease Control and Prevention, Atlanta; Dan Fisher, M.D., cardiologist, New York University Medical Center, New York City; April 22, 2002, Annals of Internal Medicine; April 24, 2002, study presentations, American Heart Association's Asia Pacific Scientific Forum, Honolulu
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