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Don't Worry, Get Mad Once in Awhile

Study finds not getting angry increases heart risk for angry people

FRIDAY, Aug. 3, 2001 (HealthDayNews) -- Don't worry if you get mad because the boss is breathing down your neck. New research suggests getting angry once in a while won't give you heart disease.

Only people who are angry all the time are at increased risk of heart disease -- not those who get angry in reaction to criticism, frustration or unfair treatment. And always being angry may create as much risk for heart disease as high blood pressure, the researchers say.

"What we did was rate people as to what kind of anger they had and then looked at the incidence of heart disease in order to come up with this finding," says Janice E. Williams, an epidemiologist with the Centers for Disease Control and Prevention (CDC). "In fact, the people we looked at were free of heart disease [when the study began], and we followed them for up to six years to look at the association between anger and heart disease."

Williams and her colleagues looked at data from The Atherosclerosis Risk in Communities Study, which explored risk factors for coronary heart disease in nearly 13,000 people in four American communities.

"In that study, which was published last year, we looked at the rate of overall anger as a personality trait," and then broke that into angry temperament and angry reaction, Williams says.

People who were always angry were almost 2.3 times more likely to have a heart attack than those who got angry just in reaction to a situation, Williams says.

"What I found was that those who were highly prone to unprovoked or minimally provoked anger were at greatest risk for heart disease," she says. "That's not to say the people who get angry in reaction to situations do not get heart disease. It's just that people with an angry personality are much more at risk."

"These findings were true among people who had normal blood pressure levels, and not true among people with high blood pressure," Williams says. "In the context of high blood pressure, the addition of an anger-prone personality may make for little additional risk for heart disease."

The findings appear in the August issue of the American Journal of Epidemiology.

Williams says people who are angry all the time may have "more detrimental health behaviors, and therefore may be more prone to obesity, more prone to high blood pressure, or they may smoke more. And there's another hypothesis -- that the direct physiological effects of anger causes a release of stress hormones in the body and those hormones have damaging effects on the arteries and the heart muscle itself. Or the release of those hormones can also cause a heart attack by leading to the rupture of a blood clot in an artery."

Both expressed or unexpressed constant anger could increase the risk, says Johnie Hamilton Jr., a spokesman for the American Stroke Association. Hamilton has studied the relationship of depression and anger to cardiovascular disease.

"What I've seen in my clinical experience is that some people have had problems with their anger. Either they haven't expressed enough or they expressed too much, and that can release stress hormones. And all those stress hormones at high levels on a constant basis can certainly lead to a lot of problems. It's like you're always on heightened alert," Hamilton says.

And all that anger can lead to compensatory behavior that increases heart disease risk, Hamilton says.

"Patients may deal with their stress by constantly eating, or constantly smoking or drinking. They go to eating or smoking or drinking because those actions are constantly rewarding and can be easier than dealing with people," he says.

"That chocolate cake is always going to taste good. It's always consistent. It's always there, and it's non-judgmental. And that's what's going to add to a person's risk," Hamilton says.

What To Do: For more information on anger and heart disease, visit the American Heart Association or Mental Health Net.

SOURCES: Interviews with Janice E. Williams, Ph.D., M.P.H., epidemiologist, CDC's cardiovascular health branch, Atlanta; Johnie Hamilton Jr., clinical psychologist, Regional Rehabilitation Center of the University Health Systems of Eastern Carolina, Greenville, N.C.; August 2001 American Journal of Epidemiology
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