When I was in medical school at Duke, there was a lot of talk about the type A personality as a risk factor for having a heart attack.  Over the decades studies have found that the primary risk factor and predictor in this personality was hostility (unresolved anger).  How do you deal with your anger?  Do you have healthy ways to resolve it, or do you “just let it rip?”

If you do, you might want to consider the findings that a new study has determined that repeated outbursts of anger, according to a recent report can trigger heart attacks, strokes and abnormal heart rhythms, known as arrhythmia.

Outbursts of anger may trigger heart attacks, strokes and other cardiovascular problems in the two hours immediately afterwards, according to researchers at Harvard University. They found that the two hours following an outburst of anger, significantly increased the risk of a heart attack, almost a five-fold increase, while the risk of a stroke tripled, compared to episodes to when the anger had not occurred.  It is the first study to systematically evaluate previous research into the link between the extreme emotion and all cardiovascular outcomes was published March 3 in the

Having an increased  risk for cardiovascular disease, including people with diabetics, or those who’d already had one heart attack, as well as those who had the highest levels of anger, were at greater risk .

According to the study’s author Dr. Elizabeth Mostofsky, “Although the risk of experiencing an acute cardiovascular event with any single outburst of anger is relatively low, the risk can accumulate for people with frequent episodes of anger. This is particularly important for people who have higher risk due to other underlying risk factors or those who have already had a heart attack, stroke or diabetes. For example, a person without many risk factors for cardiovascular disease, who has only one episode of anger per month, has a very small additional risk, but a person with multiple risk factors or a history of heart attack or stroke, and who is frequently angry, has a much higher absolute excess risk accumulated over time.”

For people who were frequently angry — like five times per day — the outbursts would result in about 158 extra heart attacks per 10,000 among people with low cardiovascular risk, rising to around 657 extra heart attacks per 10,000 among those already at high risk for heart woes.

The study didn’t look specifically at why anger triggered heart problems, but the researchers pointed out that anger increases heart rate, blood pressure and vascular resistance (the force that opposes blood flow). These changes in blood flow may lead to clots or trigger the release of inflammatory chemicals that leads to heart problems.

Dr Mostofsky said: “Previous studies have shown that outbursts of anger are associated with an immediately higher risk of cardiovascular events, including heart attack and stroke, but since some of these studies were based on small sample sizes with few patients having outbursts of anger, the results were often reported with low precision.

“Furthermore, there has been no systematic evaluation to compare the results and examine whether there is consistency across studies of the same cardiovascular outcome and whether the association is of similar magnitude across studies of different types of cardiovascular outcomes, for instance between a heart attack or a stroke. Despite the heterogeneity between the studies included in our meta-analysis, all of the studies found that compared to other times, there was a higher rate of cardiovascular events in the two hours following outbursts of anger.”

The authors say there are several potential physiological ways to link anger outbursts and cardiovascular problems. “Psychological stress has been shown to increase heart rate and blood pressure, and vascular resistance,” they write in their paper. Changes in blood flow can cause blood clots and may stimulate inflammatory responses.


  1. Think before you explode
  2. Don’t let your anger control you—you can control it.
  3. Consider an anger management course or seeing a therapist


European Heart Journal.  “Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis”, by Elizabeth Mostofsky, Elizabeth Anne Penner, and Murray A. Mittleman. European Heart Journal. doi:10.1093/eurheartj/ehu033