In efforts to dig deeper into a previously observed link between anger and heart attacks, researchers from Columbia University Irving Medical Centre, Yale School of Medicine, and St John’s University in New York, recruited a group of participants with the intention of making them angry – and confirming the earlier findings.
A total of 280 healthy young adults were randomised into four groups: a control group that counted out loud for eight minutes and maintained a neutral emotional state, and groups who recalled events that made them angry, sad or anxious.
Before they began, and at intervals for 100 minutes afterward, the researchers took blood samples and measurements of blood flow and pressure.
NBC reports that the findings, published in the Journal of the American Heart Association, show that anger may indeed affect the heart because of how it impairs blood vessel function.
The researchers found blood vessels’ ability to dilate was significantly reduced among people in the angry group compared with those in the control group. Blood vessel dilation wasn’t affected in the sadness and anxiety groups.
Dilation can be regulated by endothelial cells, which line the insides of blood vessels. By dilating and contracting, blood vessels slow down or increase the flow of blood to the parts of the body that need it.
Further tests revealed that there was no damage to the endothelial cells or to the body’s ability to repair any endothelial cell damage.
The only issue was the dilation, the study found. Impairment of how blood vessels dilate is an early marker for atherosclerosis, which is the build-up of fats and cholesterol, called plaque, on artery walls that make the arteries stiff.
Atherosclerosis can lead to coronary heart disease, heart attack, stroke and kidney disorders.
“That is why endothelium-dependent vasodilation is an important mechanism to study,” said co-author Andrea Duran, an assistant professor of medical sciences at Columbia University Irving Medical Centre.
The results of the study could help physicians persuade their patients who have heart disease and anger problems to manage their anger, through yoga, exercise, cognitive behavioural therapy or other established techniques, said Dr Holly Middlekauff, a cardiologist and a professor of medicine and physiology at UCLA’s David Geffen School of Medicine.
“It’s not widely known or widely accepted that anger does precipitate heart attacks,” said Middlekauff, who wasn’t involved with the study. “This study offers a biological plausibility to that theory, that anger is bad for you, that it raises your blood pressure, that we’re seeing impaired vascular health.”
And that may get some patients’ attention, she added.
Duran cautioned that the laboratory study is a foundational study and that further research is needed. For example, scientists don’t know exactly how anger impairs blood vessel dilation. “That would be for a future study,” she said.
In the paper, the researchers suggested several factors could be at work, including changes caused by stress hormones, increased inflammation and activation of the autonomic nervous system, which regulates involuntary processes like heart rate, blood pressure and breathing.
In addition, the researchers intentionally selected participants who were healthy, without heart disease or other chronic conditions that could confound the results. While that is a strength of the study, it also is a limitation, because the findings may not apply to older people who are ill.
“This was just the first step,” said Rebecca Campo, a psychologist and program director at the National Heart, Lung and Blood Institute, which funded the study.
Future research should look at “populations with cardiovascular disease, with diabetes and at people who live in rural settings and ethnic and racial minorities”.
Middlekauff said the biggest limitation of the study is that it looked at one bout of provoked anger.
“I’d like to see a study of a group of chronically angry people and see what their vascular function is,” she said.
Study details
Translational research of the acute effects of negative emotions on vascular endothelial health: findings from a randomised controlled study
Daichi Shimbo, Morgan Cohen, William Chaplin et al.
Published in the Journal of the American Heart Association on 1 May 2024
Abstract
Background
Provoked anger is associated with an increased risk of cardiovascular disease events. The underlying mechanism linking provoked anger as well as other core negative emotions including anxiety and sadness to cardiovascular disease remain unknown. The study objective was to examine the acute effects of provoked anger, and secondarily, anxiety and sadness on endothelial cell health.
Methods and Results
Apparently healthy adult participants (n=280) were randomized to an 8‐minute anger recall task, a depressed mood recall task, an anxiety recall task, or an emotionally neutral condition. Pre−/post‐assessments of endothelial health including endothelium‐dependent vasodilation (reactive hyperemia index), circulating endothelial cell‐derived microparticles (CD62E+, CD31+/CD42−, and CD31+/Annexin V+) and circulating bone marrow‐derived endothelial progenitor cells (CD34+/CD133+/kinase insert domain receptor+ endothelial progenitor cells and CD34+/kinase insert domain receptor+ endothelial progenitor cells) were measured. There was a group×time interaction for the anger versus neutral condition on the change in reactive hyperemia index score from baseline to 40 minutes (P=0.007) with a mean±SD change in reactive hyperemia index score of 0.20±0.67 and 0.50±0.60 in the anger and neutral conditions, respectively. For the change in reactive hyperemia index score, the anxiety versus neutral condition group by time interaction approached but did not reach statistical significance (P=0.054), and the sadness versus neutral condition group by time interaction was not statistically significant (P=0.160). There were no consistent statistically significant group×time interactions for the anger, anxiety, and sadness versus neutral condition on endothelial cell‐derived microparticles and endothelial progenitor cells from baseline to 40 minutes.
Conclusions
In this randomised controlled experimental study, a brief provocation of anger adversely affected endothelial cell health by impairing endothelium‐dependent vasodilation.
NBC News article – Science shows how a surge of anger could raise heart attack risk (Open access)
See more from MedicalBrief archive:
Intense anger increases heart risk eightfold
Emotional upset and heavy physical exertion as stroke triggers — Interstroke study
Atherosclerosis in more than 40% of Swedish adults with no known heart disease – SCAPIS
Lack of sleep increases heart attack and stroke risk