(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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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 L. G. Futterman and L. Lemberg Anger and Acute Coronary Events Am. J. Crit. Care., November 1, 2002; 11(6): 574 - 576. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Gidron, H. Gilutz, R. Berger, and M. Huleihel Molecular and cellular interface between behavior and acute coronary syndromes Cardiovasc Res, October 1, 2002; 56(1): 15 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
P. P. Chang, D. E. Ford, L. A. Meoni, N.-Y. Wang, and M. J. Klag Anger in Young Men and Subsequent Premature Cardiovascular Disease: The Precursors Study Arch Intern Med, April 22, 2002; 162(8): 901 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. MONTEBUGNOLI and C. PRATI Circulatory dynamics during dental extractions in normal, cardiac and transplant patients J Am Dent Assoc, April 1, 2002; 133(4): 468 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Matthews and B. B. Gump Chronic Work Stress and Marital Dissolution Increase Risk of Posttrial Mortality in Men From the Multiple Risk Factor Intervention Trial Arch Intern Med, February 11, 2002; 162(3): 309 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Williams, F. J. Nieto, C. P. Sanford, D. J. Couper, H. A. Tyroler, and A. Algra The Association Between Trait Anger and Incident Stroke Risk: The Atherosclerosis Risk in Communities (ARIC) Study * Editorial Comment: The Atherosclerosis Risk in Communities (ARIC) Study Stroke, January 1, 2002; 33(1): 13 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Lucini, G. Norbiato, M. Clerici, and M. Pagani Hemodynamic and Autonomic Adjustments to Real Life Stress Conditions in Humans Hypertension, January 1, 2002; 39(1): 184 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Williams, F. J. Nieto, C. P. Sanford, and H. A. Tyroler Effects of an Angry Temperament on Coronary Heart Disease Risk : The Atherosclerosis Risk in Communities Study Am. J. Epidemiol., August 1, 2001; 154(3): 230 - 235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Tsuchihashi, K. Ueshima, T. Uchida, N. Oh-mura, K. Kimura, M. Owa, M. Yoshiyama, S. Miyazaki, K. Haze, H. Ogawa, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction J. Am. Coll. Cardiol., July 1, 2001; 38(1): 11 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Mittleman, R. A. Lewis, M. Maclure, J. B. Sherwood, and J. E. Muller Triggering Myocardial Infarction by Marijuana Circulation, June 12, 2001; 103(23): 2805 - 2809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Peters, D. W. Dockery, J. E. Muller, and M. A. Mittleman Increased Particulate Air Pollution and the Triggering of Myocardial Infarction Circulation, June 12, 2001; 103(23): 2810 - 2815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Kovach, B. D. Nearing, and R. L. Verrier Angerlike behavioral state potentiates myocardial ischemia-induced T-wave alternans in canines J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1719 - 1725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Sloan, E. Bagiella, P. A. Shapiro, J. P. Kuhl, D. Chernikhova, J. Berg, and M. M. Myers Hostility, Gender, and Cardiac Autonomic Control Psychosom Med, May 1, 2001; 63(3): 434 - 440. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Martyn Hebdomadal rhythms of the heart BMJ, December 23, 2000; 321(7276): 1542 - 1543. [Full Text]
|
|
|
|