'Blowing off steam' through exercise triples heart attack risk

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Attempting to “blow off steam” through vigorous exercise could triple the risk of a heart attack within the hour, The Guardian reports experts say. Being very upset or angry more than doubles the risk of a heart attack within an hour, while heavy physical exertion does the same, a worldwide study suggested. But combining the two – such as using extreme exercise as a way of calming down – increases the risk even further.

Experts said the study – the biggest of its kind – provides evidence of a “crucial link” between mind and body.

The research suggested a doubling of the risk association between anger or emotional upset, or physical exertion, and the onset of first heart attack symptoms within one hour. The association was much stronger – just over triple the risk – for patients who said they had been angry or emotionally upset while also engaging in heavy physical exertion.

The study’s lead author, Dr Andrew Smyth, from the population health research institute at McMaster University in Canada, said extreme emotional and physical triggers are thought to have similar effects on the body. He added: “Both can raise blood pressure and heart rate, changing the flow of blood through blood vessels and reducing blood supply to the heart. This is particularly important in blood vessels already narrowed by plaque, which could block the flow of blood leading to a heart attack.

“Regular physical activity has many health benefits, including the prevention of heart disease, so we want that to continue. 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.”

Researchers analysed information from 12,461 patients from 52 countries with an average age of 58. They had completed a questionnaire about the kind of “triggers” they experienced in the hour before they had a heart attack. The results showed that 13% (1,650 people) had engaged in physical activity while 14% (1,752 people) were angry or emotionally upset.

The experts took into account the effect of other risk factors such as age, smoking, obesity, high blood pressure and other health problems.

Dr Barry Jacobs, the director of behavioural sciences at the Crozer-Keystone family medicine residency programme in Springfield, Pennsylvania, is quoted in the report as saying: “This large, nearly worldwide study provides more evidence of the crucial link between mind and body.

“Excess anger, under the wrong conditions, can cause a life-threatening heart attack. All of us should practise mental wellness and avoid losing our temper to extremes. People who are at risk for a heart attack would do best to avoid extreme emotional situations.”

Maureen Talbot, a senior cardiac nurse with the British Heart Foundation, said in the report: “This research suggests that emotional upset and excessive physical exertion can be triggers for a heart attack. Whilst this is interesting these are not the underlying causes.

“Heart attacks are mainly caused by atherosclerosis, the build-up of fatty plaque in the arteries. When plaque breaks off, a blood clot forms leading to a heart attack.

“That’s why it’s important people know their heart attack risk and take steps to reduce their risk, by quitting smoking, keeping physically active and maintaining a healthy weight.”

Background: Physical exertion, anger, and emotional upset are reported to trigger acute myocardial infarction (AMI). In the INTERHEART study, we explored the triggering association of acute physical activity and anger or emotional upset with AMI to quantify the importance of these potential triggers in a large, international population.
Methods: INTERHEART was a case-control study of first AMI in 52 countries. In this analysis, we included only cases of AMI and used a case-crossover approach to estimate odds ratios for AMI occurring within 1 hour of triggers.
Results: Of 12 461 cases of AMI 13.6% (n=1650) engaged in physical activity and 14.4% (n=1752) were angry or emotionally upset in the case period (1 hour before symptom onset). Physical activity in the case period was associated with increased odds of AMI (odds ratio, 2.31; 99% confidence interval [CI], 1.96–2.72) with a population-attributable risk of 7.7% (99% CI, 6.3–8.8). Anger or emotional upset in the case period was associated with an increased odds of AMI (odds ratio, 2.44; 99% CI, 2.06–2.89) with a population-attributable risk of 8.5% (99% CI, 7.0–9.6). There was no effect modification by geographical region, prior cardiovascular disease, cardiovascular risk factor burden, cardiovascular prevention medications, or time of day or day of onset of AMI. Both physical activity and anger or emotional upset in the case period were associated with a further increase in the odds of AMI (odds ratio, 3.05; 99% CI, 2.29–4.07; P for interaction <0.001).
Conclusions: Physical exertion and anger or emotional upset are triggers associated with first AMI in all regions of the world, in men and women, and in all age groups, with no significant effect modifiers.

Andrew Smyth, Martin O’Donnell, Pablo Lamelas, Koon Teo, Sumathy Rangarajan, Salim Yusuf

The Guardian report Circulation abstract

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