Angry outbursts up risk of heart attacks fivefold

A new study has warned that "losing it" in anger is not only harmful for your health, but it increases risk of heart attack in the two hours following the outburst nearly fivefold.

Lead author Elizabeth Mostofsky, a post-doctoral fellow in the cardiovascular epidemiological unit at Beth Israel Deaconess Medical, and colleagues performed a systematic review of studies published between 1966 and 2013.

They identified nine case crossover studies where patients who had experienced cardiovascular events answered questions about anger.

They were asked about their level of anger immediately prior to the cardiovascular event with anger at other times, using terms like very angry, furious or enraged.

The researchers found that despite differences between the studies, there was "consistent evidence of a higher risk of cardiovascular events immediately following outbursts of anger".

The study results showed that the risk of heart attack or acute coronary syndrome - the symptoms like chest pain, shortness of breath or sweating related to a blocked artery - was 4.7 times higher in the two hours following an angry outburst than at any other time.

And the risk for stroke caused by a blocked artery in the brain was 3.6 times higher than at other times. One of the studies included in the review indicated a 6.3 fold increased risk for brain aneurysm in the hour following an outburst of anger compared with other times.

Mostofsky and colleagues also examined two studies that looked at arrhythmia and anger.

Analysis of these studies showed that patients with implanted cardiac defibrillators (ICD) were nearly twice as likely to experience an abnormal heart rate requiring a shock from the ICD in the 15 minutes following an angry outburst than at other times.

Senior author Murray Mittleman, a physician in the CardioVascular Institute at BIDMC, said that it's important to bear in mind that while these results show a significantly higher risk of a cardiovascular event associated with an angry outburst, the overall risk for people without other risk factors like smoking or high blood pressure is relatively small.

"However, we should be concerned about the occurrence of angry outbursts with our higher risk patients and our patients who have frequent outbursts of anger," Mittleman said.

The study is published in the European Heart Journal.