If someone cuts you off on the freeway, do you become consumed with rage? Are you constantly aggravated with your boyfriend, or at odds with your family? This kind of behavior may be impacting more than your relationships—it may be damaging your health. In fact, according to a new study, men who harbor anger and hostility are likely to find themselves at a substantially increased risk for heart disease. It's not enough to quit smoking and start eating right—men in particular also need to monitor their mental health as part of a heart-healthy lifestyle.
Though there is a common perception that anger is bad for one's health, the scientific evidence for this has been inconclusive up to this point. Enter the current study, which appears in the March 17 issue of the Journal of the American College of Cardiology. Researchers at University College, London reviewed existing studies on the association, over time, of anger and hostility with cardiac events. In fact, there are 25 studies of this relationship in healthy populations, and 19 studies involving people already ill with coronary heart disease, or CHD. The researchers found a strong correlation in both populations between anger or hostility and CHD: the regular experience of these emotions was associated with a 19 percent increase in coronary events among people who were (at least at the initiation of the relevant studies) healthy, and a 24 percent increase in such events among people already ill with CHD. Those are substantial increases, and led the researchers to conclude, in the words of Drs. Johan Denollet and Susanne Pedersen of Tilburg University in The Netherlands, who co-authored the journal's editorial response to the study, "Clinicians should take symptoms of anger and hostility seriously, and may consider referring their patient for behavioral intervention. We need to closely monitor and study these personality traits in order to do a better job at identifying high-risk patients who are more liable to future fatal and non-fatal coronary events."
Before you start punching out your computer screen, let's ask—are all angry people at risk? Maybe—but perhaps not to equal degrees. In particular, it seems that men need to watch their anger more, the study authors conclude. The association between anger or hostility and heart events, particularly in healthy people, was found more strongly in men than in women. As one of the study's authors, Yoichi Chida of University College, London, commented to the press, "This suggests that the accumulation of stress responses in daily life might have a great impact on future coronary heart disease in men." But gender is only one of the terms complicating the results of this study. In fact, once researchers took into account the effects of behavioral choices such as smoking, exercise (or lack thereof), and obesity, the anger effect seemed to diminish. What does that mean? Potentially, that behavioral risk factors for coronary heart disease open the door for psychological risk factors such as hostility and anger to negatively impact heart health. You could probably guess this, but it's best to stay away from the tobacco while you're working on your anger management.
All of this suggests that the relationship between psychological factors and heart disease is, not surprisingly, quite complex. In their editorial response, Drs. Denollet and Pedersen argue that anger and hostility are among a number of psychological factors that, they say, "might cluster together within individuals to substantially increase the risk of clinical events". In fact, Denollet and Pedersen point out that anger and hostility are really separate factors, impacting the body along with depression and anxiety, both of which are also associated with heart disease. These psychological experiences are often all found in a single individual, of course, but to varying degrees. The variation in the mix of what one might term the "psychological cocktail" makes it difficult to determine which factors are the greatest relative culprits in cardiac illness. Or, as Denellot and Pedersen succinctly point out, "It is difficult to conduct a meta-analysis that catches this complexity."
Ideally, we would all be less anxious, depressed, angry, and hostile, of course. Likewise, we would not smoke, drink, be overweight or fail to exercise. But that is not the reality that patients and doctors face on a daily basis. At the very least, the British study and responding editorial suggest that doctors need to ask patients a series of questions to determine, not only their behavioral risk-factors for heart disease, but their psychological risk-factors as well. At the same time, all of us as patients need to be more aware of the impact that our psychology may have on our heart health and ask for help in improving our emotional fitness even as we work on our smoking-cessation, weight, and fitness.
This is especially true for us as men. Heart disease is the leading cause of death for American men. Nearly 10 percent of caucasian men and over seven percent of African-American men have CHD. Nearly half of men who have a heart attack before the age of 65 will die within eight years, and over 70 percent of sudden cardiac events occur in men. Likewise, men are less likely to seek treatment for depression than women, though some six million American men suffer from depression each year. It is a common misconception that psychological factors impact only women's health, and not men's. As the London study indicates, if you are experiencing symptoms of depression, or find that you have trouble managing your anger, there is more at stake than your peace of mind. For your heart's sake, seek help right away.