If a caller upsets you, do you hurl the phone across the room? Do you curse and blast the horn furiously if the driver in front of you takes three seconds to notice the green light? An angry temperament can hurt more than relationships -- anger and heart disease may go hand in hand, according to experts.
"You're talking about people who seem to experience high levels of anger very frequently," says Laura Kubzansky, PhD, MPH, an assistant professor at the Harvard School of Public Health who has studied the role of stress and emotion on cardiovascular disease.
Moderate anger may not be the problem, she says. In fact, expressing one's anger in reasonable ways can be healthy. "Being able to tell people that you're angry can be extremely functional," she says.
But explosive people who throw things or scream at others may be at greater risk, as well as those who harbor suppressed rage, she says. "Either end of the continuum is problematic."
Gender doesn't appear to make much difference, she adds. "Once people are chronically angry, men and women seem to be at equally high risk."
Scientists don't all agree that anger plays a role in heart disease, she says. But many studies have suggested a significant link. "I think the case is strong," Kubzansky says.
For example, one large study published in Circulation in 2000 found that among 12,986 middle-aged African-American and white men and women, those who rated high in traits such as anger -- but had normal blood pressure -- were more prone to coronary artery disease (CAD) or heart attack. In fact, the angriest people faced roughly twice the risk of CAD and almost three times the risk of heart attack compared to subjects with the lowest levels of anger.
Anger may not be the only culprit in heart disease risk. Kubzansky's own research suggests that other extreme, negative emotions may contribute, too. "Anger is a problem, but so, too, are high levels of anxiety and depression. They tend to co-occur. People who are angry a lot also tend to have other chronic negative emotions as well.
Anger and Heart Disease: What's the Connection?
How might hotheads be hurting their hearts?
Scientists speculate that anger may produce direct biological effects on the heart and arteries. Negative emotions, such as anger, quickly activate the "fight-or-flight response." They also trigger the "stress axis," Kubzansky says. "That's a slightly slower response, but it activates a cascade of neurochemicals that are all geared toward helping you in the short run if you're facing a crisis."
While these stress responses mobilize us for emergencies, they might cause harm if repeatedly activated. "When they persist over time, they end up being potentially damaging," she says.
For example, excessive amounts of stress hormones may speed up the process of atherosclerosis, in which fatty plaques build up in arteries, Kubzansky says.
Anger may also disrupt the electrical impulses of the heart and provoke dangerous heart rhythm disturbances.
Other research suggests that stress hormones may lead to higher levels of C-reactive protein (CRP), a substance linked to atherosclerosis and future heart disease risk. In 2004, Duke University scientists who studied 127 healthy men and women found that those prone to anger, hostility, and depression had two to three times higher CRP levels than their more placid peers.
"CRP levels at this range are associated with inflammation that is likely to eventually increase the risk of a heart attack or stroke," says researcher Edward Suarez, PhD. The findings were published in Psychosomatic Medicine.
Besides direct biological effects, lifestyle factors also come into play. Angry people may take worse care of themselves. "People who are chronically distressed may not behave in health-promoting ways," Kubzansky says. "We know that anxious, depressed, angry people are more likely to smoke, less likely to engage in physical activity, have poor nutritional habits and drink to excess."
Anger -- as well as anxiety, depression and other negative emotions -- are a part of life, Kubzansky says. They can serve useful purposes. "But if people find that they have them chronically and at high levels and can't seem to get away from it, I view it like pain. It's a signal that something needs to change. This is not how it's supposed to be."
Anger and Heart Disease: How to Get Anger Under Control
Anger is intertwined with other problems that may end up harming the heart, says psychologist Wayne Sotile, PhD. "If you mismanage anger, it's going to compromise your most intimate relationships," he says. "It's going to isolate you from others. The likelihood increases that you'll get depressed, and you're going to cause problems in your life that increase anxiety and worry."
Sotile is director of psychological services for the Wake Forest University Healthy Exercise and Lifestyle Programs and a special consultant in behavioral health for the Center for Cardiovascular Health at Carolinas Medical Center in Charlotte, N.C.
Counseling and anger management classes can help the chronically angry to get their deep-seated emotions under control. But you can take more immediate steps, too, experts say.
First, when you feel the heat rising, figure out how to calm yourself. "You do this by learning to recognize the signs that your fuse has been lit and stamping it out before you explode," Sotile writes in his book, Thriving with Heart Disease.
For example, some experts recommend taking a time out by counting to 10 before responding or by walking away from the situation.
Countering angry thoughts helps, too, Sotile says. "When you're angry, remind yourself that others are usually doing their best. No one sets out in the morning with the mission to infuriate you."
He suggests that people keep in mind these "coping statements" to help them get a grip and avoid blasting someone:
- "I can't accomplish anything by blaming other people, even if they are responsible for the problem. I'll try another angle."
- "Will this matter five years from now? (Five hours? Five minutes?)"
- "If I'm still angry about this tomorrow, I'll deal with it then. But for now, I'm just going to cool off."
- "Acting angry is not the same as showing that I care."
- "Let me ask, rather than tell."
- "I'll listen rather than talk."
- "The fastest way is not necessarily the best way except in a life-or-death situation, and this is not one of them."
Last, regular exercise provides an outlet for stress and anger, and it cuts heart disease risk in other ways, too, says Rita Redberg, MD, MSc, a professor and director of Women's Cardiovascular Services at the University of California, San Francisco Medical Center. "Physical activity is an excellent way to reduce your heart disease risk because it reduces stress, anger, hostility. It also reduces your blood pressure and raises your good cholesterol and lowers your weight."