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men who react to stress with anger are at significantly increased
risk for premature heart disease Young men who quickly react to stress with anger are at three times the baseline risk of developing premature heart disease, according to an American study of more than 1,000 physicians published in the April 22nd issue of the Archives of Internal Medicine. In addition, such men -- who said they expressed or concealed their anger, became irritable or engaged in complaint sessions -- were five times more likely than their calmer counterparts to have an early myocardial infarction even without a family history of heart disease. "In this study, hot tempers predicted disease long before other traditional risk factors like diabetes and hypertension became apparent," says Patricia P. Chang, M.D., lead author of the study. "The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management." Chang and colleagues analyzed data from the Johns Hopkins Precursors Study, a long-term investigation of 1,337 medical students who were enrolled at Johns Hopkins medical School between 1948 and 1964 who continue to be followed. In medical school and through the follow-up period, information on family history and health behaviors has been collected. For this report, the investigators tracked 1,055 men for an average of 36 years following medical school to examine the risk of premature and total cardiovascular disease associated with anger responses to stress during early adult life. During medical school and in 1992, all participants were given a "nervous tension" questionnaire that sought clues to how they responded to undue pressure or stress. Expressed or concealed anger, irritability and complaint sessions were the three responses defined as indicating the most anger. When they responded to the questionnaire during medical school, 229 men said they expressed or concealed their anger, 169 said they engaged in complaint sessions and 99 said they were irritable. A total of 21 men reported the highest level of anger (all three items) in response to stress. By age 76 years, 205 men (35 percent) had developed cardiovascular disease, with an average onset at age 56 years. Of those, 145 men had coronary heart disease (94 with myocardial infarction) and 59 reported a stroke. Premature cardiovascular disease was found in 77 men (8 percent), with an average onset at age 49 years. Of those, 56 had coronary heart disease (34 with myocardial infarction) and 13 reported premature stroke. "Although the number of
heart events was small, the incidence of cardiovascular disease
was significantly higher for those with the highest level of anger
compared with those with lower levels of anger," Chang says.
Although it is not known how anger contributes to heart disease,
Chang says evidence points to stress-related release of extra catecholamines.
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