TRIGGERING OF ACUTE MYOCARDIAL-INFARCTION ONSET BY EPISODES OF ANGER

Background Many anecdotes and several uncontrolled case series have su ggested that emotionally stressful events, and more specifically, ange r, immediately precede and appear to trigger the onset of acute myocar dial infarction. However, controlled studies to determine the relative risk of myocardial infarction after episodes of anger have not been r eported. Methods and Results We interviewed 1623 patients (501 women) an average of 4 days after myocardial infarction. The interview identi fied the time, place, and quality of myocardial infarction pain and ot her symptoms, the estimated usual frequency of anger during the previo us year, and the intensity and timing of anger and other potentially t riggering factors during the 26 hours before the onset of myocardial i nfarction. Anger was assessed by the onset anger scale, a single-item, seven-level, self-report scale, and the state anger subscale of the S tate-Trait Personality Inventory. Occurrence of anger in the 2 hours p receding the onset of myocardial infarction was compared with its expe cted frequency using two types of self-matched control data based on t he case-crossover study design. The onset anger scale identified 39 pa tients with episodes of anger in the 2 hours before the onset of myoca rdial infarction. The relative risk of myocardial infarction in the 2 hours after an episode of anger was 2.3 (95% confidence interval, 1.7 to 3.2). The state anger subscale corroborated these findings with a r elative risk of 1.9 (95% confidence interval, 1.3 to 2.7). Regular use rs of aspirin had a significantly lower relative risk (1.4; 95% confid ence interval, 0.8 to 2.6) than nonusers (2.9; 95% confidence interval , 2.0 to 4.1) (P<.05). Conclusions Episodes of anger are capable of tr iggering the onset of acute myocardial infarction, but aspirin may red uce this risk. A better understanding of the manner in which external events trigger the onset of acute cardiovascular events may lead to in novative preventive strategies aimed at severing the link between thes e external stressors and their pathological consequences.