Anger, heavy physical exertion may trigger MIs

A case-control study found that heavy physical exertion and anger or emotional upset were associated with first acute MIs in men and women in all regions of the world. The risk was highest among patients who had both heavy physical exertion and anger or emotional upset.

Lead researcher Andrew Smyth, PhD, of Hamilton Health Sciences and McMaster University in Ontario, Canada, and colleagues published their results Oct. 10 in Circulation.

“Previous studies have explored these heart attack triggers; however, they had fewer participants or were completed in one country, and data are limited from many parts of the world,” Smyth said in a news release. “This is the first study to represent so many regions of the world, including the majority of the world’s major ethnic groups.”

The researchers analyzed 12,461 cases of acute MI that occurred in the INTERHEART study, which enrolled patients in 262 centers in 52 countries. AstraZeneca, Novartis, Aventis, Abbott, Bristol Myers Squibb, King Pharma and Sanofi provided unrestricted grants and helped fund the study

The mean age was 58.1 years old, and 75.9 percent of patients were males.

Participants answered questions on whether they engaged in heavy physical exertion or were angry or emotionally upset before their acute MIs. They also submitted data on age, ethnicity, diet, physical activity, tobacco use, education and cardiovascular risk factors and provided other information.

The researchers found that 13.6 percent of patients engaged in physical activity and 14.4 percent were angry or emotionally upset in the hour before symptom onset.

They said that heavy physical activity was associated with increased odds of acute MU. The population-attributable risk was 7.7 percent. They added that there was no statistically significant effect modification on analyses stratified by age group, sex, smoking, diabetes, hypertension, obesity, angina, stroke risk score or baseline physical activity.

Anger or emotional upset was also associated with increased odds of acute MI. The population-attributable risk was 8.5 percent. There was no statistically significant effect modification on analyses modified by age group, sex, smoking, diabetes, hypertension, obesity, angina, stroke risk score, levels of stress, depression or level of education.

The results were consistent across geographical regions, according to the researchers.

“This large, nearly worldwide study provides more evidence of the crucial link between mind and body,” Barry J. Jacobs, Psyd, an American Heart Association volunteer and director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, said in a news release. “Excess anger, under the wrong conditions, can cause a life-threatening heart attack. All of us should practice mental wellness and avoid losing our temper to extremes.”

The researchers acknowledged a few potential limitations of the study, including its observational design, which meant they could not establish causation. Participants also self-reported the potential triggering events, and the researchers did not use objective scales. In addition, the study was subject to recall bias. Further, the researchers only analyzed patients hospitalized with acute MI, so the results might not be generalizable to all patients who had an acute MI.

“People who are at risk for a heart attack would do best to avoid extreme emotional situations,” Jacobs said. “One way many cope with the emotional ups and downs of a health condition is through peer support, talking with others who are facing similar challenges can be very helpful in better managing your own emotions.”