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September 21, 2006

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Illustration by Georgia Bellas/Harvard News Office

Anger can break your heart

A hostile heart is a vulnerable heart

By William J. Cromie
Harvard News Office

Think about this the next time someone cuts you off in traffic or in a grocery store line: Anger can bring on a heart attack or stroke.

• Read the full text of Simon's article

• Take an anger quiz

That's the conclusion of several studies at Harvard Medical School and elsewhere. One study of 1,305 men with an average age of 62 revealed that the angriest men were three times more likely to develop heart disease than the most placid ones.

Angry older men, as stereotypes go, are most vulnerable. But excessive ire can take a toll at any age. Researchers at Johns Hopkins School of Medicine tracked 1,055 medical students for 36 years. Compared with cooler heads, the hotheads were six times more likely to suffer heart attacks by age 55 and three times more likely to develop any form of heart or blood vessel disease.

The conclusion is clear: Anger is bad for you at any age. "Among young adults, it's a predictor of premature heart disease later in life," says Harvey Simon, an associate professor of medicine at Harvard Medical School.

Most anger research has focused on men, so whether the same risk applies to women remains unknown. One study, published in 1995, found that, during two hours after an angry outburst, a individual's risk of having a heart attack was more than twice that of someone who had not lost their cool. Out of 1,623 people in that study, 501 were women.

"Almost all the anger research I'm familiar with has focused on men," notes Simon. "However, based on a 2006 study of road rage, I would guess that women are less prone to severe anger and thus to its deleterious effects, which include heart attack, stroke, and even impaired lung function."

A Harvard study, published in August, concluded that men who showed high hostility at the start of the eight-year investigation exhibited significantly poorer lung function at the end of it. "This research shows that hostility is associated with poorer [lung] function and more rapid rates of decline among older men," notes Rosalind Wright, an assistant professor at the Harvard School of Public Health.

Strokes of anger

Over the years, then, anger increases a man's and, probably less so, a woman's chances of heart disease. But, what about a single burst of rage, the guy who cuts in front of you just before the exit ramp? The answer apparently is "yes." In the Harvard study of 1,623 patients, which included 501 women, intensive anger more than doubled their risk of heart attack if the emotion occurred in the two hours previous to the heart attack.

In an evaluation of 200 stroke patients in Israel, researchers linked a bout of intense anger to a 14-fold increase in risk of stroke within two hours of the emotional incident.

Results from a study published this year found that of more than 2,500 patients treated in emergency rooms in Missouri hospitals, about 500 of them were torn by anger just before the injury. The greater the anger, the higher the risk, researchers concluded.

Anger comes in many doses: annoyance, irritability, frustration, vexation, resentment, animosity, ire, indignation, wrath, and rage, for example. Most people know when they're mad. If not, someone is bound to tell them so, sooner or later.

Psychologists have developed a scale that rates anger levels. It's a true-or-false test that presents statements like: "At times I feel like smashing things." "I easily become impatient with people," "I've been so angry at times that I've hurt someone in a physical fight."

Once you decide how irate you are, you need to decide what to do about it. For a start you can see your family doctor about the wisdom of taking an aspirin a day. Harvard researchers recently found that a single low-dose (81 mg) pill can reduce anger-caused heart attacks by 40 percent. In other words, a daily aspirin may cut the risk of breaking an angry heart by almost half.

How to be cool

Simon adds more advice in the September issue of Harvard Men's Health Watch, which he edits. "Try to identify the things that bother you most and do your best to change them," he suggests. "Learn to recognize warning signs of building tension, such as a racing pulse, fast breathing, or a jumpy, restless feeling. When you recognize such signals, take steps to relieve the tension. Often something as simple as a walk can cool things down."

Don't boil in silence. Talk out your feelings with your spouse, partner, or a good friend. If that doesn't work, write down your feelings. Try to explain to yourself why you are so irritated or vexed.

Simon also suggests learning to meditate, or experimenting with deep breathing exercises. Also, you can, with practice, change behaviors that light your fuse. Here are some examples: Don't always try to have the last word. Try not to raise your voice. Don't curse. Wait a few seconds when you feel on outburst coming on then try to express yourself calmly. Don't grimace or clench your teeth. Practice smiling.

If all such efforts fail, angry people can seek professional help. A 2002 study reported that stress management classes can protect men from anger-induced heart problems, and individual counseling may be even better.

Another possible resource involves evidence that some antidepressants may help protect against a broken heart. "Depression is hard on the heart," Simon says. "We think, although it hasn't been proven, that easing depression will ease anger as well."

"Regular exercise," Simon adds, "is also an excellent way to reduce both mental stress and physical risk factors like blood pressure, cholesterol, blood sugar, insulin, and body fat. And whether your fuse is short or long, you should never light up or expose yourself to tobacco in any form. And always be aware that emotions affect your health as much as diet and exercise. The link between mind and heart is strong."


Copyright 2006 by the President and Fellows of Harvard College