HARVARD GAZETTE ARCHIVES
By William J. Cromie
Are you irritable, grouchy, impatient, hot-headed?
At times, do you feel like swearing, smashing things, kicking that slow person at the head of the line?
If so, you're advised to take an aspirin and chill out.
It makes common sense to believe that anger is bad for your heart. Ichiro Kawachi, assistant professor of medicine, and his colleagues at the Medical School have measured just how bad.
Grumpy old men, they found, have three times the risk of heart disease than their cooler peers. Kawachi's group asked 1,305 men, mean age 62, questions like those above, then ranked them on a scale of 0 to 14. The higher the score, they concluded, the higher the risk of a heart attack, or heart-related chest pain (angina).
The researchers tested the men in 1986 and followed them for seven years, In that time, 110 cases of heart disease occurred, including 20 fatal and 30 nonfatal heart attacks.
"The tripling of risk," Kawachi says, "involves high levels of anger, explosive anger that includes smashing things and wanting to hurt someone in a fight."
No women were included in the study, but Kawachi believes anger affects them the same way. In a telephone interview, he mentioned another Harvard study that found this to be true.
Murray Mittleman of the Medical School and Deaconess Hospital rated 1,122 men and 501 women who had suffered heart attacks on a scale from "hassled" to "enraged." Mittleman concluded that the risk of heart attack more than doubles (2.3 times) in the two hours following moderate to intense anger.
"Our study demonstrates a longer term increase in the risk among older men," Kawachi says.
So what's a grumpy person to do? Those in the Deaconess study who took aspirin regularly could get angry without increasing their risk of heart attack. Kawachi concludes that aspirin offers a "moderate protective effect," lowering heart attack risk from 15 percent to 40 percent. However, he would like to see more studies done on the subject before making any recommendations about its use.
Many doctors advise taking a baby aspirin daily to reduce the chances of blood clots forming. Before taking adult aspirins on a regular basis, it is best to check with one's doctor.
How It May Work
No one really knows how anger increases the chance of a heart attack, but researchers have some good ideas. These include release of stress hormones, increased oxygen demand by the heart's muscle cells, and added stickiness of blood platelets, which leads to clots.
Aspirin reduces stickiness, which also can be increased by stress hormones such as adrenaline.
Kawachi recommends that a first line of defense for smokers would be to stop smoking. "People think of nicotine as a stress reliever, but in the long term it does more harm than good," he says. "Exercise is a better way to reduce stress, and it keeps weight under control."
The angriest men in his study were heavier, more likely to smoke and to take at least two alcoholic drinks a day.
Kawachi acknowledges the difficulty of changing situations that make people angry, such as traffic jams, insensitive bosses, or unpleasant social situations. He suggests that one long-term solution may be anger management counseling or courses.
These could be tailored to individuals and take into account differences in the way men and women handle anger. "Women, especially those in low-status jobs, tend to bottle up their anger," Kawachisays. "However, further studies of anger and heart disease are needed to establish just who can benefit from such programs."
A numbers of researchers have focused on a hard-driving, impatient (type A) personality, and on hostility, as high risk factors for heart attacks. The first connection fell apart, and the second was based on tests that didn't really measure anger.
"Our findings with respect to anger stand apart from most previous reports of hostility and heart disease," Kawachi maintains. These tests actually measure cynical mistrust, not hostility. "Cynicism and anger are conceptually distinct," he continues. "Cynicism is characterized by a tendency to hold misanthropic beliefs, including the attribution of selfish motives to other people's acts. Anger, by contrast, refers to the unpleasant emotional state ranging in intensity from mild irritation or annoyance to rage and fury. We found no evidence of an association between cynicism and heart disease."
Kawachi and his colleagues reported the details of their study in the latest issue of Circulation, a journal published by the American Heart Association.
Copyright 1998 President and Fellows of Harvard College