So it's not helpful getting vein bursting angry at your doctor for KNOWING NOTHING ON GETTING YOU 100% RECOVERED! You'll just have to hope schadenfreude hits her/him when they are the 1 in 4 per WHO that has a stroke?
If
your doctor wrote three prescriptions to OT, PT and ST of E.T.(Evaluate
and Treat) that means your doctor is no better than a trained monkey as
far as getting you recovered! You still have to remain calm.
New Research Could Help Explain Anger’s Link to Heart Attacks and Strokes
Observational studies have associated anger with increased risks of myocardial infarction—heart attack—and stroke, but little has been known about the mechanism behind this phenomenon. Now, the results of a randomized clinical trial published in the Journal of the American Heart Association suggest that anger may affect blood vessel dilation, offering a possible explanation.
The researchers, supported by the National Institutes of Health (NIH), aimed to examine how negative emotions affect the blood vessels.
“This study adds to our body of knowledge that acute negative psychological events, such as stress or anger, can have real physiologic effects,” said cardiologist Glenn Levine, MD, a professor at Baylor College of Medicine who was not involved with the study.
The Backstory
Although there’s plenty of conversation around psychiatric conditions and physical health, Daichi Shimbo, MD, the study’s lead author and a cardiologist at Columbia University Medical Center, wanted to investigate the physiological influences of negative emotions that everyone experiences from time to time. “When we think about mental health, we think about severe chronic conditions like depression, anxiety, posttraumatic stress disorder, and so forth,” he said. “What we don’t talk about is negative emotions.”
After seeing data linking both short-term and long-term risk of heart disease to anger and sadness, he wondered what could cause this correlation. He worked with fellow researchers to design a study centering around 3 core emotions: anger, transient anxiety, and stress.
The Trial Design
The trial involved 280 participants between the ages of 18 and 73 years with no history of hypertension, diabetes, lipid imbalance, or mood disorders, who were assigned to various conditions designed to induce specific emotions:
• Either an anger or an anxiety recall task: participants were asked to recall an event that made them angry or anxious and talk about it for 8 minutes.
• A depressed mood task: participants were asked to read scripts off slides that became progressively sadder for 8 minutes.
• A neutral task: participants in this control group counted out loud for 8 minutes.
The recall tasks for anger and anxiety were based on validated methods designed to elicit the negative emotions felt at specific points in the participants’ lives.
“Obviously what may make you angry is different than what makes me angry,” Shimbo said. “There’s individual stimuli that cause people to have these negative emotions.”
The depressed mood task relied on the Velten Mood Induction Procedure, a validated measure for inducing sadness. Because the simple act of talking can affect blood vessel function, the control condition included a speaking component, but it was designed to be somewhat boring, Shimbo explained.
Researchers measured flow changes in the blood vessels of each participant’s dominant arm with a blood pressure cuff, an intravenous catheter, and a finger probe immediately after the negative emotion induction or the neutral task and then again after 3, 40, 70, and 100 minutes.
The Results
They found that:
• Blood vessel dilation was significantly reduced in the anger induction group compared with the control group.
• There was no statistically significant difference in blood vessel dilation between the anxiety or sadness induction conditions and the control group.
• Vessel impairment in the anger induction condition persisted for up to 40 minutes before returning to the baseline.
“This study suggests that a short episode of anger may be linked to vascular impairments or the ability of the vessels to dilate,” said Rebecca Campo, PhD, a social-health psychologist and program director at the NIH’s National Heart, Lung, and Blood Institute, which funded the work. “The idea is that if this is something that occurs frequently, it could be a precursor to the kind of long-term damage that can lead to heart attacks and strokes.”
It's important to note that the emotional induction lasted only 8 minutes and was on a scale between mild and moderate. Shimbo pointed out that this level of emotional annoyance is in line with what people experience every day and yet it impaired healthy blood vessel dilation for up to 40 minutes.
“I speculate if you’re a person who gets angry a lot, you’re chronically insulting your arteries,” he said. “I think over time it’s going to reach a point that it’s going to be chronically dysfunctional. And that’s the step toward getting atherosclerosis and heart disease.”
The Biological Mechanisms
Healthy blood vessels regularly undergo the process of vasodilation, where they widen to allow increased blood flow, helping to deliver oxygen and nutrients throughout the body. Part of this is dependent on the health of the endothelial cells, which line the blood vessels and release vasoactive factors.
Impairment of vasodilation, caused by the loss of normal endothelial function, promotes numerous processes that lead to the buildup of plaque in the arteries, known as atherosclerosis.
This study is one of the first to show that anger affects blood vessel function, and so the intermediary mechanisms that connect these variables aren’t yet fully understood. However, researchers proposed several potential pathways to explore in the future.
Levine hypothesized that the sympathetic nervous system’s activity plays a role.
“We can categorize things like anger and stress together,” he said. “We know in the short-term, episodes like that can increase adrenaline levels and sympathetic tone. Your heart rate goes up, your blood pressure goes up, your body releases adrenaline, and these can lead to increased oxygen demand by your heart. These can lead to constriction of your coronary arteries.”
But Shimbo, who codirects the Columbia Hypertension Center, is somewhat skeptical of this explanation because the increase in blood pressure in the study was similar for both the anxiety and anger conditions but only the latter was associated with impaired vasodilation.
In his view, a connection with the powerful vasoconstrictor endothelin 1, which is released when a person feels stress, is a more likely explanation. He noted it’s also possible that anger affects vascular function through the inflammatory cascade, the body’s process of responding to trauma by recruiting immune cells and chemical mediators.
The Takeaways
Based on the study, Shimbo said that cardiovascular researchers should distinguish between different negative feelings.
“I was surprised that sadness and anxiety didn’t have negative effects on blood vessel function and anger did,” he said. “I think that tells you that maybe we shouldn’t put all these negative emotions into one bucket.”
Although there’s still a lot to learn about the connection between anger and heart disease, the results of this study provide a basis for additional work.
“Controlled laboratory studies such as this are an important starting point for understanding basic biological mechanisms underlying emotions and health outcomes,” Campo said.
Campo also noted several limitations inherent to the study design. Although focusing on a relatively young and healthy population removes some confounding variables, the results are not widely generalizable.
“The participants were free of any cardiovascular disease; they weren’t taking any cardiovascular medication,” she said, adding that the study wasn’t conducted in a real-life setting and “didn’t examine populations at risk for health disparities.”
Additionally, the study did not examine the chronic effects of anger—but future work could try and tackle this issue. Shimbo is also interested in testing the impact of cognitive behavioral therapy on vascular function or finding a medication to reduce the physiological effects of anger.
In the meantime, clinicians can use these preliminary findings to advise patients on various anger management strategies to protect their long-term cardiovascular health.
For patients who “get chest discomfort when they get angered or stressed, this is a real phenomenon,” Levine said. “It’s not just in their mind. It is good to explore mechanisms where they can learn to better deal with situations that might cause stress, frustration, or anger.”
Published Online: May 31, 2024. doi:10.1001/jama.2024.9776
Conflict of Interest Disclosures: No disclosures were reported.
