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Eur Heart J. 2014 Jun 1;35(21):1404-10. doi: 10.1093/eurheartj/ehu033. Epub 2014 Mar 3.

Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis.

Author information

1
Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Avenue, Room 423, Boston, MA 02215, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
2
Department of Internal Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
3
Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Avenue, Room 423, Boston, MA 02215, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA mmittlem@bidmc.harvard.edu.

Abstract

AIM:

Short-term psychological stress is associated with an immediate physiological response and may be associated with a transiently higher risk of cardiovascular events. The aim of this study was to determine whether brief episodes of anger trigger the onset of acute myocardial infarction (MI), acute coronary syndromes (ACS), ischaemic and haemorrhagic stroke, and ventricular arrhythmia.

METHODS AND RESULTS:

We performed a systematic review of studies evaluating whether outbursts of anger are associated with the short-term risk of heart attacks, strokes, and disturbances in cardiac rhythm that occur in everyday life. We performed a literature search of the CINAHL, Embase, PubMed, and PsycINFO databases from January 1966 to June 2013 and reviewed the reference lists of retrieved articles and included meeting abstracts and unpublished results from experts in the field. Incidence rate ratios and 95% confidence intervals were calculated with inverse-variance-weighted random-effect models. The systematic review included nine independent case-crossover studies of anger outbursts and MI/ACS (four studies), ischaemic stroke (two studies), ruptured intracranial aneurysm (one study), and ventricular arrhythmia (two studies). There was evidence of substantial heterogeneity between the studies (I(2) = 92.5% for MI/ACS and 89.8% for ischaemic stroke). Despite the heterogeneity, all studies found that, compared with other times, there was a higher rate of cardiovascular events in the 2h following outbursts of anger.

CONCLUSION:

There is a higher risk of cardiovascular events shortly after outbursts of anger.

KEYWORDS:

Anger; Cardiovascular disease; Case-crossover; Epidemiology

PMID:
24591550
PMCID:
PMC4043318
DOI:
10.1093/eurheartj/ehu033
[Indexed for MEDLINE]
Free PMC Article

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