Being angry or upset may increase the chance of a first heart attack for high-risk people—and the odds could climb further when anger is combined with exercise, according to a new study published in Circulation, the journal of the American Heart Association (AHA).
The study included more than 12,000 people from 52 countries who had experienced their first heart attack. The study is notable for its size. Andrew Smyth, lead author of the study and a researcher at McMaster University's Population Health Research Institute, said, "Previous studies have explored these heart attack triggers; however, they had fewer participants or were completed in one country."
After being hospitalized, each patient in the study was asked if they were "engaged in heavy physical exertion" or were "angry or emotionally upset" at two different times:
- In the hour before they had a heart attack; and
- In the same one-hour period the day prior to suffering a heart attack.
Using this data, the researchers—after accounting for other cardiovascular risk factors such as obesity and a history of stroke—calculated that:
- Experiencing either physical exertion or emotional stress doubled the risk of undergoing a heart attack within the next hour among those in the study; and
- Experiencing both tripled the risk.
According to an AHA release, the researchers "said that these triggers appeared to independently increase a person’s heart attack risk beyond that posed by other risk factors, including age, smoking, obesity, high blood pressure and other health problems."
Understanding the connection
The relationship between physical and mental stress and a heart attack makes sense, the researchers said, because of the physiology of a how a heart attack occurs. According to the study, such exertion can increase blood pressure and pulse rate, which can cause plaque in an artery to rupture and cut off blood flow to the heart.
However, Smyth noted that exercise, in general, is still a vital part of maintaining cardiovascular health. "Regular physical activity has many health benefits, including the prevention of heart disease, so we want that to continue," he explained. "However, we would recommend that a person who is angry or upset who wants to exercise to blow off steam not go beyond their normal routine to extremes of activity."
Barry Jacobs, an AHA volunteer and director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program, who not involved in the study, said, "People who are at risk for a heart attack would do best to avoid extreme emotional situations."
The researchers noted that many people face "external triggers" such as anger without having a heart attack. "So, it's likely that those triggers come into play only when a person has artery-clogging plaques that are particularly vulnerable to rupturing," Amy Norton writes for HealthDay (Lukits, Wall Street Journal, 10/31; AHA release, 10/10; Norton, HealthDay, 10/10).
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