Feelings of anger disrupt endothelial function, which may raise heart disease risk
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Key takeaways:
- An angry emotional state may impair blood vessel function, but the underlying mechanism is unclear.
- The findings suggest anger management interventions may help reduce heart disease risk.
Disruptions in endothelial function caused by brief bouts of elicited anger may be an early predictor of heart disease, but the underlying mechanism remains unclear, researchers reported.
The results of the laboratory-based, randomized controlled experimental PUME study were published in the Journal of the American Heart Association.
“Impaired vascular function is linked to an increased risk of heart attack and stroke,” Daichi Shimbo, MD, professor of medicine at the Columbia University Irving Medical Center, said in a press release from the AHA. “Observational studies have linked feelings of negative emotions with having a heart attack or other cardiovascular disease events. The most common negative emotion studied is anger, and there are fewer studies on anxiety and sadness, which have also been linked to heart attack risk.”
Eliciting emotional responses for study
For this study, Shimbo and colleagues recruited 280 apparently healthy adults from the community surrounding Columbia University Irving Medical Center.
From August 2013 to May 2017, participants were randomly assigned to one of four tasks: anger recall, anxiety recall, depressed mood recall and an emotionally neutral condition.
At the start of the study, participants were escorted to a temperature-controlled study room and seated in a comfortable chair, where they were instructed to relax for 30 minutes without talking, using their phones, reading or sleeping.
After 30 minutes, baseline measures of endothelial cell health were obtained, including flow-mediated endothelium-dependent vasodilation, endothelial cell injury and endothelial cell reparative capacity.
“Evidence suggests that endothelial dysfunction is an early pathogenic process underlying atherosclerosis development and CVD event onset,” the researchers wrote.
Next, participants assigned to anger or anxiety recall tasks were asked to think on personal memories that would evoke those emotions for 8 minutes.
Those assigned to depression recall underwent Velten mood induction, which involved participants reading descriptors that evoke sadness for 8 minutes.
Participants assigned to an emotionally neutral condition were asked to count aloud from one to 100, repeatedly, until 8 minutes had passed.
Measurements of endothelial cell health were repeated at 3, 40, 70 and 100 minutes after the assigned task was completed.
Emotional state and endothelial function
“We saw that evoking an angered state led to blood vessel dysfunction, though we don’t yet understand what may cause these changes,” Shimbo said in the release. “Investigation into the underlying links between anger and blood vessel dysfunction may help identify effective intervention targets for people at increased risk of cardiovascular events.”
From baseline to 40 minutes, Shimbo and colleagues observed interaction between anger recall and endothelium-dependent vasodilation compared with the emotionally neutral condition (P = .007).
The researchers reported no effect on endothelium-dependent vasodilation in the anxiety recall (P = .054) or depression recall groups (P = .16) compared with the emotionally neutral condition.
“If you’re a person who gets angry all the time, you’re having chronic injuries to your blood vessels,” Shimbo said in a press release from the NHLBI, which funded the study. “It’s these chronic injuries over time that may eventually cause irreversible effects on vascular health and eventually increase your heart disease risk.”
There was no significant association between anger, anxiety and depression recall and endothelial cell injury or endothelial cell reparative capacity from baseline to 40 minutes compared with the neutral condition.
“This study adds nicely to the growing evidence base that mental well-being can affect cardiovascular health, and that intense acute emotional states, such as anger or stress, may lead to cardiovascular events,” Glenn Levine, MD, FAHA, master clinician and professor of medicine at Baylor College of Medicine and chief of the cardiology section at the Michael E. DeBakey VA Medical Center, who chaired the writing committee of an AHA scientific statement on psychological health, well-being and the mind-heart-body connection, said in the release from the AHA. “For instance, we know that intense sadness or similar emotions are a common trigger for takotsubo cardiomyopathy, and events such as earthquakes or even as a fan watching a world soccer match, which provoke stress, may lead to myocardial infarction and/or to arrhythmias. This current study very eloquently shows how anger can negatively impact vascular endothelial health and function, and we know the vascular endothelium, the lining of blood vessels, is a key player in myocardial ischemia and atherosclerotic heart disease. While not all the mechanisms on how psychological states and health impact cardiovascular health have been elucidated, this study clearly takes us one step closer to defining such mechanisms.”
“We’ve long suspected, based on observational studies, that anger can negatively affect the heart. This study in healthy adults helps fill a real knowledge gap and shows how this might occur,” Laurie Friedman Donze, PhD, a psychologist and program officer in the Clinical Applications and Prevention Branch of the NHLBI, said in the release from the NHLBI. “It also opens the door to promoting anger management interventions as a way to potentially help stave off heart disease, the leading cause of death in this country.”
References:
- Brief anger may impair blood vessel function. https://newsroom.heart.org/news/brief-anger-may-impair-blood-vessel-function. Published May 1, 2024. Accessed on May 1, 2024.
- NIH-funded clinical trial links frequent anger to increased risk of heart disease. https://www.nhlbi.nih.gov/news/2024/nih-funded-clinical-trial-links-frequent-anger-increased-risk-heart-disease. Published May 1, 2024. Accessed May 1, 2024.
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