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The hostile heart: anger as a trigger for acute cardiovascular events

Suzanne V. Arnold, John A. Spertus, Brahmajee K. Nallamothu
DOI: http://dx.doi.org/10.1093/eurheartj/ehu097 First published online: 4 March 2014

This editorial refers to ‘Outbursts of anger as a trigger of acute cardiovascular events: a systematic review andmeta-analysis’, by E. Mostofsky et al., doi:10.1093/eurheartj/ehu033.

The link between anger and adverse cardiovascular events is well ingrained in both patients' and clinicians' minds. Mediated through increases in circulating catecholamines, increased myocardial oxygen demand, coronary vasospasm, and increased platelet aggregability, anger can cause transient ischaemia, disruption of vulnerable plaques, and increased thrombotic potential. These changes can then result in myocardial or cerebral ischaemia or malignant arrhythmias.1 Multiple studies have shown that acute mental stress (in a laboratory setting) can provoke ischaemia of similar or greater severity and extent to exercise in 40–70% of patients with coronary artery disease,2,3 and this ischaemia increases the long-term risk of fatal and non-fatal cardiac events.4,5 In addition, T-wave alternans induced by mental stress in a laboratory has been shown to predict future ventricular arrhythmias in patients with implantable defibrillators.6

While the long-term link between chronic mental stress, anxiety, depression, and hostility with adverse cardiovascular events has been well established, it has been more difficult to determine the short-term risk of an acute outburst of anger. Ideally, understanding this risk would require large, prospective epidemiological studies that track outbursts of anger and …

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