(Circulation. 1995;92:1720-1725.)
© 1995 American Heart Association, Inc.
Articles |
Triggering of Acute Myocardial Infarction Onset by Episodes of Anger
From the Institute for Prevention of Cardiovascular Disease (M.A.M., M.M., J.B.S., R.P.M., G.H.T., J.E.M.), Cardiovascular Division, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston, Mass; the Department of Epidemiology (M.A.M., M.M.), Harvard School of Public Health, Boston; the Mind/Body Medical Institute (S.C.J., R.F., H.B.), Division of Behavioral Medicine, Department of Medicine, Deaconess Hospital, Harvard Medical School, Boston; and the Department of Psychiatry (R.F.), State University of New York, Stony Brook.
Correspondence to Murray A. Mittleman, MDCM, DrPH, Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Deaconess Hospital, 1 Autumn St, Fifth Floor, Boston, MA 02215.
Background Many anecdotes and several uncontrolled case series have suggested that emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute myocardial infarction. However, controlled studies to determine the relative risk of myocardial infarction after episodes of anger have not been reported.
Methods and Results We interviewed 1623 patients (501 women) an average of 4 days after myocardial infarction. The interview identified the time, place, and quality of myocardial infarction pain and other symptoms, the estimated usual frequency of anger during the previous year, and the intensity and timing of anger and other potentially triggering factors during the 26 hours before the onset of myocardial infarction. Anger was assessed by the onset anger scale, a single-item, seven-level, self-report scale, and the state anger subscale of the State-Trait Personality Inventory. Occurrence of anger in the 2 hours preceding the onset of myocardial infarction was compared with its expected frequency using two types of self-matched control data based on the case-crossover study design. The onset anger scale identified 39 patients with episodes of anger in the 2 hours before the onset of myocardial infarction. The relative risk of myocardial infarction in the 2 hours after an episode of anger was 2.3 (95% confidence interval, 1.7 to 3.2). The state anger subscale corroborated these findings with a relative risk of 1.9 (95% confidence interval, 1.3 to 2.7). Regular users of aspirin had a significantly lower relative risk (1.4; 95% confidence interval, 0.8 to 2.6) than nonusers (2.9; 95% confidence interval, 2.0 to 4.1) (P<.05).
Conclusions Episodes of anger are capable of triggering the onset of acute myocardial infarction, but aspirin may reduce this risk. A better understanding of the manner in which external events trigger the onset of acute cardiovascular events may lead to innovative preventive strategies aimed at severing the link between these external stressors and their pathological consequences.
Key Words: myocardial infarction • anger
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A. W. Siegman, S. T. Townsend, A. C. Civelek, and R. S. Blumenthal Antagonistic Behavior, Dominance, Hostility, and Coronary Heart Disease Psychosom Med, March 1, 2000; 62(2): 248 - 257. [Abstract] [Full Text] [PDF]
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H.-R Arntz, S.N Willich, C Schreiber, T Bruggemann, R Stern, and H.-P Schultheiss Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24061 consecutive cases Eur. Heart J., February 2, 2000; 21(4): 315 - 320. [Abstract] [PDF]
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R. Lampert, D. Jain, M. M. Burg, W. P. Batsford, and C. A. McPherson Destabilizing Effects of Mental Stress on Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators Circulation, January 18, 2000; 101(2): 158 - 164. [Abstract] [Full Text] [PDF]
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 M. Greene, D. Newman, M. Geist, M. Paquette, D. Heng, and P. Dorian Is electrical storm in ICD patients the sign of a dying heart?: Outcome of patients with clusters of ventricular tachyarrhythmias Europace, January 1, 2000; 2(3): 263 - 269. [Abstract] [PDF]
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N. Christenfeld, L. M. Glynn, D. P. Phillips, and I. Shrira Exposure to New York City as a Risk Factor for Heart Attack Mortality Psychosom Med, November 1, 1999; 61(6): 740 - 743. [Abstract] [Full Text] [PDF]
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J. Moller, J. Hallqvist, F. Diderichsen, T. Theorell, C. Reuterwall, and A. Ahlbom Do Episodes of Anger Trigger Myocardial Infarction? A Case-Crossover Analysis in the Stockholm Heart Epidemiology Program (SHEEP) Psychosom Med, November 1, 1999; 61(6): 842 - 849. [Abstract] [Full Text] [PDF]
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A STEPTOE Psychosocial factors in the aetiology of coronary heart disease Heart, September 1, 1999; 82(3): 258 - 259. [Full Text] [PDF]
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R. B. Williams A 69-Year-Old Man With Anger and Angina JAMA, August 25, 1999; 282(8): 763 - 770. [Full Text] [PDF]
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G. Piccirillo, E. Viola, M. Nocco, E. Santagada, M. Durante, C. Bucca, and V. Marigliano Autonomic Modulation and QT Interval Dispersion in Hypertensive Subjects With Anxiety Hypertension, August 1, 1999; 34(2): 242 - 246. [Abstract] [Full Text] [PDF]
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J. E. J. Gallacher, J. W. G. Yarnell, P. M. Sweetnam, P. C. Elwood, and S. A. Stansfeld Anger and Incident Heart Disease in the Caerphilly Study Psychosom Med, July 1, 1999; 61(4): 446 - 453. [Abstract] [Full Text] [PDF]
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W. J. Kop Chronic and Acute Psychological Risk Factors for Clinical Manifestations of Coronary Artery Disease Psychosom Med, July 1, 1999; 61(4): 476 - 487. [Abstract] [Full Text] [PDF]
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M. A. Mittleman, D. Mintzer, M. Maclure, G. H. Tofler, J. B. Sherwood, and J. E. Muller Triggering of Myocardial Infarction by Cocaine Circulation, June 1, 1999; 99(21): 2737 - 2741. [Abstract] [Full Text] [PDF]
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P. H. Stone, D. S. Krantz, R. P. McMahon, A. D. Goldberg, L. C. Becker, B. R. Chaitman, H. A. Taylor, J. D. Cohen, K. E. Freedland, B. D. Bertolet, et al. Relationship among mental stress-induced ischemia and ischemia during daily life and during exercise: the Psychophysiologic Investigations of Myocardial Ischemia (PIMI) Study J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1476 - 1484. [Abstract] [Full Text] [PDF]
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A. Rozanski, J. A. Blumenthal, and J. Kaplan Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy Circulation, April 27, 1999; 99(16): 2192 - 2217. [Abstract] [Full Text] [PDF]
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S. A. Everson, G. A. Kaplan, D. E. Goldberg, T. A. Lakka, J. Sivenius, and J. T. Salonen Anger Expression and Incident Stroke : Prospective Evidence From the Kuopio Ischemic Heart Disease Study Stroke, March 1, 1999; 30(3): 523 - 528. [Abstract] [Full Text] [PDF]
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 S. N Willich Circadian variation and triggering of cardiovascular events Vascular Medicine, February 1, 1999; 4(1): 41 - 49. [Abstract] [PDF]
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J. D. Folts, A. I. Schafer, J. Loscalzo, J. T. Willerson, and J. E. Muller A perspective on the potential problems with aspirin as an antithrombotic agent: a comparison of studies in an animal model with clinical trials J. Am. Coll. Cardiol., February 1, 1999; 33(2): 295 - 303. [Abstract] [Full Text] [PDF]
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T. C. Andrews, J. D. Parker, S. Jacobs, R. Friedman, N. Cummings, G. MacCallum, F. Mannting, G. H. Tofler, W. Carlson, J. E. Muller, et al. Effects of therapy with nifedipine GITS or atenolol on mental stress-induced ischemic left ventricular dysfunction J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1680 - 1686. [Abstract] [Full Text] [PDF]
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I. Kawachi, D. Sparrow, L. D. Kubzansky, A. Spiro, P. S. Vokonas, and S. T. Weiss Prospective Study of a Self-Report Type A Scale and Risk of Coronary Heart Disease : Test of the MMPI-2 Type A Scale Circulation, August 4, 1998; 98(5): 405 - 412. [Abstract] [Full Text]
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J. Denollet and D. L. Brutsaert Personality, Disease Severity, and the Risk of Long-term Cardiac Events in Patients With a Decreased Ejection Fraction After Myocardial Infarction Circulation, January 20, 1998; 97(2): 167 - 173. [Abstract] [Full Text] [PDF]
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 G. J. Ter Horst and F. Postema Forebrain parasympathetic control of heart activity: retrograde transneuronal viral labeling in rats Am J Physiol Heart Circ Physiol, December 1, 1997; 273(6): H2926 - H2930. [Abstract] [Full Text] [PDF]
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C. E. Lavery, M. A. Mittleman, M. C. Cohen, J. E. Muller, and R. L. Verrier Nonuniform Nighttime Distribution of Acute Cardiac Events : A Possible Effect of Sleep States Circulation, November 18, 1997; 96(10): 3321 - 3327. [Abstract] [Full Text]
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J. E. Muller, P. G. Kaufmann, R. V. Luepker, M. L. Weisfeldt, P. C. Deedwania, and J. T. Willerson Mechanisms Precipitating Acute Cardiac Events : Review and Recommendations of an NHLBI Workshop Circulation, November 4, 1997; 96(9): 3233 - 3239. [Full Text]
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