Anger: Heartbreaking at any age

Everyone gets angry from time to time. It's a normal human response to unfair treatment and other injustices, and it's a common reaction to frustration and criticism, whether justified or not. But normal anger is one thing, excessive hostility quite another. Some people get angry without provocation, others react excessively to minor adversity, and still others experience inappropriately intense or prolonged anger to legitimate triggers.

Outbursts of anger are never pretty, and they can damage relationships and careers. Anger can also bring on heart disease. But older men are most vulnerable to heart disease, while younger men are more likely to have short fuses. Does youthful anger affect the mature heart? Studies of anger and heart disease say the answer is yes: Excessive anger at any age can take a toll on men in midlife and beyond.

Hostility at Harvard

The hostile heart is a vulnerable heart. Harvard researchers have demonstrated that anger has both short- and long-term consequences. In a longitudinal study, scientists evaluated 1,305 men with an average age of 62. Each participant took a psychological test that used the Minnesota Multiphasic Personality Inventory anger scale to rate his anger level. The men returned for detailed medical exams every 3 to 5 years; they were checked for heart disease and cardiac risk factors such as smoking, hypertension, high cholesterol, and diabetes. None of the men had coronary artery disease at the start of the study, but 110 developed it within 7 years. All in all, the angriest men were three times more likely to develop heart disease than the most placid men. The link between anger and heart disease was not explained by differences in blood pressure, smoking, or other cardiac risk factors; hostility was heartbreaking in its own right.

Over the long run, anger can increase a middle-aged man's risk of developing coronary artery disease, but can a single burst of anger trigger a heart attack? Another Harvard study found that it could. Doctors interviewed 1,623 patients about four days after they had suffered a heart attack; 69% were men. The patients used the Anger Onset Scale to rate the intensity of any episodes of anger they had experienced during the 26 hours prior to their attacks, as well as throughout the previous year. Intensive anger was clearly dangerous for the heart, more than doubling the risk of heart attack if the emotion took place in the two hours previous to the heart attack.

Anger and stroke

Heart attack and stroke share many risk factors, from cholesterol to hypertension. And an Israeli study adds anger to the list. The research evaluated 200 consecutive stroke patients and found that an experience of intense anger was linked to a 14-fold increase in the risk of stroke within two hours of the negative emotion.

Keep it in mind the next time you feel like blowing your top.

Other studies

Although some folks at Yale might disagree, Harvard does not have a monopoly on hostility. The nationwide MRFIT Study reported that high-hostility men were 1.6 times more likely to die from coronary artery disease than their more placid peers. Similarly, scientists in Nova Scotia found that hostility more than doubled the risk of recurrent heart attacks in men (but not women). Other studies have linked hostility to an increased prevalence of cardiac risk factors, to decreased survival in men with coronary artery disease below the age of 61, to an increased risk of heart attack in men with the metabolic syndrome, and to an increased risk of abnormal heart rhythms. And to make matters worse, hostility often coexists with depression, which is a cardiac risk factor in and of itself.

Anger in youth

Most research that links anger and heart disease focuses on mature men, who are vulnerable because of their age, regardless of anger or other cardiac risk factors. But scientists at Johns Hopkins looked back to the years 1948–1964 to see if anger in young adulthood was associated with heart disease in maturity. The subjects were 1,055 men who volunteered for the Johns Hopkins Precursors Study as medical students. Each man answered questions on a personality test that rated anger, and each underwent a comprehensive medical exam. Researchers tracked the men for an average of 36 years, during which time they evaluated family history, body weight, smoking, drinking, blood pressure, cholesterol, blood sugar, and depression. Even after these risk factors were taken into account, however, anger in young adulthood emerged as a predictor of premature heart disease. Compared with their peers, the angriest medical students were six times more likely to suffer heart attacks by 55 and three times more likely to develop any form of cardiovascular disease.

Intermittent explosive disorder

Although the name may seem better suited to Iraq, intermittent explosive disorder (IED) is a legitimate psychiatric condition. While IED is sometimes expressed as road rage, it can occur on or off the highway; in fact, these explosive outbursts of rage and aggression are more likely to be triggered at home than on the road.

A 2006 survey reported that IED is surprisingly common, occurring in at least 5% of the U.S. population. The problem often begins in adolescence. Many patients also suffer from anxiety, depression, or substance abuse. On average, a person with IED will have 43 outbursts during the course of a lifetime, resulting in $1,349 in property damage — to say nothing of damage to health, family, and employment.

IED is anger with a capital A.

Mechanisms

How does hostility harm the heart? Like other forms of stress, anger triggers a surge in adrenaline, the stress hormone that boosts the blood pressure and pulse rate, increasing the heart's workload and multiplying its need for oxygen. Adrenaline can also provoke abnormal heart rhythms, including potentially lethal ventricular arrhythmias. In addition, the hormone activates platelets, the tiny blood cells that trigger blood clots that can block arteries narrowed by the cholesterol-laden plaques of atherosclerosis. High levels of anger can even provoke spasm in a coronary artery, which results in the additional narrowing of a partially blocked blood vessel.

Are you angry?

Most angry men know it — and if they don't, a friend or relative can usually attest to their excessive hostility (if they dare to speak up). But for an objective evaluation, you can use the same scales used in the Harvard studies of anger in maturity (see below).

How angry are you?

To evaluate your long-term tendency toward hostility, use the Minnesota Multiphasic Personality Inventory anger scale.

Answer true or false to each of these questions:

  1. At times I feel like swearing.

  2. At times I feel like smashing things.

  3. Often I can't understand why I've been so irritable and grouchy.

  4. At times I feel like picking a fistfight with someone.

  5. I easily become impatient with people.

  6. I am often said to be hotheaded.

  7. I am often so annoyed when someone tries to get ahead of me in a line of people that I speak to the person about it.

  8. I have at times had to be rough with people who were rude or annoying.

  9. I am often sorry because I am so irritable and grouchy.

  10. It makes me angry to have people hurry me.

  11. I am very stubborn.

  12. Sometimes I get so angry and upset, I don't know what comes over me.

  13. I have gotten angry and broken furniture or dishes when I was drinking.

  14. I have become so angry with someone that I have felt as if I would explode.

  15. I've been so angry at times that I've hurt someone in a physical fight.

  16. I almost never lose self-control.

For questions 1–15, each "true" scores 1 point; for question 16 "false" scores 1 point. The higher your total, the higher your anger level.

To evaluate how angry you are at any particular time, use the Anger Onset Scale:

If you score high on either test, don't let hostility make you mad — or sick. Instead, take measures to calm down for a healthy heart.

What to do

In 1989, Harvard's Physicians' Health Study reported that men over 50 can reduce their risk of heart attack by taking low doses of aspirin, which is usually prescribed these days as 81 mg a day. More recently, Harvard researchers found that a single aspirin tablet can reduce the likelihood of an anger-induced heart attack by 40%. In both cases, aspirin protects by inhibiting platelets, thus preventing artery-blocking blood clots.

Aspirin may help, but you can do more. Try to identify the things that bother you most and do your best to change them. Learn to recognize the warning signs of building tension, such as a racing pulse, fast breathing, or a jumpy, restless feeling. When you recognize these signals, take steps to relieve the tension before it builds to the boiling point. Often something as simple as a brief walk or a snack can cool things down nicely. Build strong relationships and talk out your feelings instead of bottling them up inside. If it's difficult for you to articulate your anger, try writing a letter that expresses these feelings. Establish priorities; set realistic expectations and pace yourself, building in time to relax. Get enough sleep. Don't try to calm yourself with nicotine, alcohol, or drugs. Think positively and make time for activities that are stimulating and enjoyable.

Professional treatment can also help. A 2002 study reported that stress management classes can protect men from stress-induced heart problems, and individual counseling may be even better. Doctors haven't yet reported on the possible cardiac benefits of anti-anxiety medications, but they have found that certain antidepressants may help protect a broken heart.

Even without professional help and medication, you can benefit from stress-reducing techniques. Consider learning how to meditate. Or experiment with deep breathing exercises:

  • Breathe in through your nose slowly and deeply, pushing your abdomen out so your diaphragm contracts maximally.

  • Hold your breath for a few seconds.

  • Exhale slowly through your mouth, thinking, "relax."

  • Repeat the sequence five to 10 times, concentrating on breathing slowly and deeply.

You can also use behavioral techniques to help stay calm. Practice during your daily life so you'll be able to keep your cool in times of stress:

  • Drive your car in the slow right-hand lane.

  • When you approach a toll plaza, join the longest line, even if you have the exact change.

  • Use your car horn only to prevent car accidents, not to vent frustration.

  • Eat slowly.

  • Talk slowly; try not to interrupt others.

  • Don't put in the last word in an argument, even if you think you're right.

  • Don't raise your voice in anger.

  • Don't use expletives; substitute less hostile phrases like "darn" or "rats."

  • Don't permit outbursts of anger; instead wait for a few moments, take a few deep breaths, and express yourself calmly.

  • Try not to grimace or clench your teeth; practice smiling.

Anger and injury

Heart attacks and strokes are bad enough, but can excessive anger also boost a man's risk of injury? According to a 2006 study from Missouri, the answer is yes. Data from more than 2,500 patients who went to the emergency ward for an acute injury showed that 20% experienced anger just before the injury. The greater the anger, the higher the risk; extreme anger was linked to a sevenfold increase in the likelihood of injury.

Anger leads to aggressive or careless behavior. And the link between anger and injury is much stronger in men than women.

Mind and body

A short fuse is not the only thing that can ignite a heart attack. To protect your health, take care of your body as well as your mind. Regular exercise is an excellent way to reduce both mental stress and physical risk factors such as blood pressure, cholesterol, blood sugar and insulin, and body fat. And whether your fuse is short or long, you should never light up or expose yourself to tobacco in any form.

Regular medical care is also important. Recognizing that heart disease begins in youth, the American Heart Association (AHA) recommends that doctors begin screening for risk factors at the age of 20 by checking for hypertension, abnormal cholesterol levels, diabetes, obesity, smoking, drinking, dietary habits, and lack of exercise. The AHA did not recommend screening young men for anger and stress, but the Johns Hopkins study implies it might be a good idea.

Like long-term health habits, personality traits are important for a long and healthy life. As William Wordsworth wrote in 1807, "The child is father of the man."