Road Rage–like Anger Linked to Increased Cardiovascular Risk

Chronic mental stress, anxiety, depression, and anger have been linked to adverse cardiovascular outcomes. Short-term psychological stress results in an immediate physiological response and may be associated with a transiently higher risk of cardiovascular events. A recent report published in European Heart Journal suggests that the systemic impact of short outbursts of intense anger can increase the risk of stroke (approximately 4-fold); myocardial infarction (MI) (approximately 5-fold); and of life-threatening ventricular arrhythmia in the 2 hours following the outburst (compared with periods when the person is not angry).

This study was a systematic review and meta-analysis of nine existing cross-over studies from 1966 to 2013 that demonstrated a significantly higher absolute risk for post-anger cardiovascular events in those with 2 specific coexisting risk factors-a history of cardiovascular problems and frequent anger outbursts. There were a total of 4546 cases of MI, 462 cases of acute coronary syndrome (ACS), 590 cases of ischemic stroke, 215 cases of hemorrhagic stroke, and 306 cases of arrhythmia represented in this meta-analysis. On the basis of their analysis, the authors concluded that 1 case of ACS per 10,000 people per year could be expected in low-risk patients-those who were severely angry only once a month. This risk rose to 158 cases of ACS per 10,000 people per year with patients who had 5 episodes of intense anger a day and rose even higher to 657 extra heart attacks per 10,000 people in high-risk patients-those with both a worse preexisting cardiovascular risk profile (per Framingham risk score) and frequent angry outbursts.

This is the first study to systematically evaluate the association between short-lived emotional outbursts and cardiovascular risk, and although is it small and observational in nature, it provides an important take-home message. Physicians don’t routinely ask about anger and response to short-term stressors during office visits. Routine screening for the tendency toward episodes of rage, however, may be important to incorporate to reduce cardiovascular risk.

References:

• Mostofsky E, Penner EA, Mittleman MA. Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis. Eur Heart J. doi:10.1093/eurheartj/ehu033.
• Arnold SV, Spertus JA, Nallamothu BK. The hostile heart: anger as a trigger for acute cardiovascular events” Eur Heart J. doi:10.1093/eurheartj/ehu097.