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Triggering of acute coronary occlusion by episodes of anger
Thomas Buckley1, Soon Y Soo Hoo2, Judith Fethney3
1Department of Cardiology, Royal North Shore Hospital, Sydney, Australia Sydney Nursing School, University of Sydney, Australia tom.buckley@sydney.edu.au.
Insights
Intense anger episodes within two hours of symptom onset significantly increase the risk of acute myocardial infarction (MI). Increased anxiety also correlates with coronary occlusion, suggesting emotional states impact heart health.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Epidemiology
Background:
- Acute myocardial infarction (MI) is a leading cause of mortality worldwide.
- Emotional triggers, such as anger, are suspected to precipitate cardiovascular events.
- Understanding the link between psychological distress and MI is crucial for preventive strategies.
Purpose of the Study:
- To investigate the association between episodes of intense anger and the occurrence of acute myocardial infarction (MI).
- To explore the relationship between anxiety levels and angiographically confirmed coronary occlusion.
Main Methods:
- A case-crossover study design was employed with 313 participants experiencing acute coronary occlusion.
- Participants reported anger episode frequency in the 48 hours preceding MI symptom onset.
- Anger levels (1-7 scale) and anxiety scores (State-Trait Personality Inventory) were assessed relative to MI onset.
Main Results:
- A significantly elevated relative risk (RR=8.5) of MI symptoms was observed within 2 hours of experiencing intense anger (level ≥5).
- Anger episodes between 2-4 hours prior to symptom onset were not associated with increased MI risk.
- High anxiety scores (above 75th percentile) were linked to a 2.0-fold increased risk of coronary occlusion, with a 9.5-fold risk for those above the 90th percentile.
Conclusions:
- Intense anger, characterized by physical tension and clenching, is a significant risk factor for acute coronary occlusion.
- Elevated anxiety levels are also associated with an increased risk of coronary occlusion.
- Further research into emotional triggers and modifiers may inform MI prevention strategies during acute emotional episodes.
Aims:
The aim of this study was to report the association between episodes of anger and acute myocardial infarction (MI) in patients with angiographically confirmed coronary occlusion.
Methods And Results:
313 participants with acute coronary occlusion (Thrombolysis In Myocardial Infarction 0 or 1 at emergency angiography) reported frequency of anger episodes in the 48 h prior to MI. In primary analysis, anger exposures within 2 h and 2-4 h prior to symptom onset were compared with subjects' own usual yearly exposure to anger using case-crossover methodology. Anger level ≥5 (on an anger scale of 1-7) was reported by seven (2.2%) participants within 2 h of MI. Compared with usual frequency, the relative risk of onset of MI symptoms occurring within 2 h of anger level ≥5 (defined as very angry) was 8.5 (95% confidence interval 4.1-17.6). Anger level <5 was not associated with onset of MI symptoms. Compared with 24-26 h pre MI, anxiety scores >75th percentile on State-Trait Personality Inventory were associated with a relative risk of 2.0 (95% confidence interval 1.1-3.8) and in those above the 90th percentile, the relative risk of MI symptom onset was 9.5 (95% confidence interval 2.2-40.8).
Conclusion:
Findings confirm that episodes of intense anger, defined as being 'very angry, body tense, clenching fists or teeth' (within 2 h) are associated with increased relative risk for acute coronary occlusion. Additionally, increased anxiety was associated with coronary occlusion. Further study, including the role of potential modifiers, may provide insight into prevention of MI during acute emotional episodes.