Heartfelt anger (by APRIL CHONG in Mind your Body of the Straits Times dated 2010-02-4)

I am so angry that my blood pressure keeps rising. This is a comment we often make in a fit of rage.

It may be more than just talk though. Experts are now saying that anger can lead to heart problems.

An international group of researchers recently analysed findings from 44 studies conducted in the United States, Europe, Asia and Australia. Their report published in the Journal Of The American College Of Cardiology showed a link between emotions and heart disease.

Chronically angry or hostile people with no history of heart problems are 19 per cent more likely to develop heart disease than calmer people.

Angry people who already have heart problems were also 24 per cent more likely to be struck down by the disease than other heart patients.

The possible culprit: hormones triggered during the anger attack.

Anger causes the release of 'fight or flight" hormones such as adrenaline and cortisol. These hormones cause blood vessels to narrow, the heart to pump faster and blood pressure to rise.
An increased blood pressure is meant to carry blood to the muscles faster during a stressful event.

'However, frequent and repeated episodes may lead to hardening of the arteries and result in high blood pressure that becomes irreversible.

'High blood pressure is a risk factor for subsequent heart disease,' said Dr Paul Chiam, a cardiology consultant at the National Heart Centre.

In addition, frequent anger episodes may damage blood vessels and hasten the process of atherosclerosis, in which cholesterol deposits or plaque build up in the arteries.

Elevated blood pressure puts a heavy stress on the arterial walls, which affects the lining of these walls and may 'destabilise' cholesterol plaque too, said Dr Chiam.

These now unstable plaque can rupture and lead to the narrowing or blockage of arteries, bringing about chest pain or heart attacks.

While yelling and throwing things around is not good for the heart, stifling your anger is equally harmful.

The Stress Research Institute at Stockholm University in Sweden studied almost 3,000 men and found that those who bottle up their rage at work are up to five times more likely to get a heart attack than those who let their anger show.

Hence, anger control is the key.

But it is not just anger. Any emotional state such as fear, bereavement and frustration can trigger the stress hormones, said cardiology consultant Jimmy Lim of the Novena Heart Centre.
For example, he said, there was a 25per cent increase in heart attacks reported in England when England lost to Argentina during a penalty shootout during the 1998 World Cup.

Senior consultant Adrian Low from the National University Heart Centre's cardiac department, who routinely handles heart attack cases, sees five to 10 patients a year who come in because of an acute emotional event, mainly one that involves bereavement or anger.

While he has not come across anyone collapsing after, say, watching a comedy, he does not rule out the possibility of 'happy' emotions triggering heart problems.

The closest cases he has encountered are patients who had a heart attack during sexual intercourse.

While patients with existing conditions such as high blood pressure and blocked arteries are at higher risk of being felled during an angry episode, doctors also caution that the 'fight or flight' hormones may affect the heart directly even for those with no discernable blockages.

An example of one such condition is called takotsubo, or the octopus-catching pot, syndrome, said Dr Lim.

First described in Japan, it refers to the condition where the left ventricle of the heart takes on the shape of an octopus-catching pot used by Japanese fishermen. The pot has a round bottom and narrow neck. This produces chest pains.

As this abnormal heart contraction can be triggered by emotional stress, it is commonly called the broken-heart syndrome.

So keep anger at bay, doctors say, even if it may be easier said than done.

In addition, one should keep to a healthy diet, have a physically active lifestyle and stay positive under stress.

Why let anger hurt the heart?