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Angry outbursts triggered short-term risk for CV events
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Outbursts of anger were associated with increased short-term risk for MI, stroke and disruptions in cardiac rhythm, according to a systematic review and meta-analysis.
Researchers conducted a literature search of the CINAHL, Embase, PubMed and PsycINFO databases for studies published between 1966 and June 2013, and they incorporated nine independent case-crossover studies in analysis. The studies included seven published between 1995 and 2013, one pertaining to anger as a precipitator of arrhythmia and an unpublished analysis of anger as a catalyst for ischemic stroke. The researchers estimated the absolute risk for CV events associated with outbursts of anger for individuals at low (5%), medium (10%) and high (20%) 10-year risk for CHD.
The meta-analysis included 4,546 cases of MI, 462 cases of ACS, 590 cases of ischemic stroke, 215 cases of hemorrhagic stroke and 306 cases of arrhythmia. Two studies evaluated MI and two assessed ACS as an endpoint. The researchers also noted that two studies restricted analysis to incident events, and two included both recurrent and incident events. Across these four studies, patients were at significantly increased risk for either MI or ACS within 2 hours of an anger outburst compared with other times (RR=4.74; 95% CI, 2.5-8.99), although researchers noted significant heterogeneity between studies (I2=92.5%; P<.001).
The association was stronger among studies evaluating incident events specifically (incidence rate ratio [IRR]=5.47; 95% CI, 3.83-7.8) than for those that included both incident and recurrent events (IRR=4.17; 95% CI, 1.42-12.26). Results also were stronger among the studies evaluating the risk for ACS (IRR=6.45; 95% CI, 4.8–8.99) rather than MI (IRR=3.52; 95% CI, 1.54-8.06). Sensitivity analysis excluding individual studies did not significantly alter results.
Meta-analysis of two studies evaluating the effect of anger outbursts on ischemic stroke risk indicated a nonsignificant increase within 2 hours of an outburst (RR=3.62; 95% CI, 0.82-16.08) compared with other times, with significant evidence of heterogeneity (I2=89.8%; P=.002). Meta-analysis of one study and one meeting abstract indicating an association between anger outbursts and ventricular arrhythmia were not possible, as they incorporated different designs, anger measures and hazard periods, but researchers wrote that both studies indicated significantly increased risk after an outburst.
“Despite the differences between the studies, there was consistent evidence of a higher risk of CV events immediately following outbursts of anger,” the researchers concluded. “… Now that there is consistent evidence that anger outbursts are associated with a transiently higher risk of CV events, further research is needed to identify effective pharmacological and behavioral interventions to mitigate the risk of CV events triggered by outbursts of anger.”
Disclosure: The researchers report no relevant financial disclosures.
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