Association between anger and mental stress–induced myocardial ischemia

Abstract

Background Mental stress-induced myocardial ischemia is associated with adverse prognosis in coronary artery disease patients. Anger is thought to be a trigger of acute coronary syndromes and is associated with increased cardiovascular risk; however, little direct evidence exists for a link between anger and myocardial ischemia. Methods [99mTc]sestamibi single-photon emission tomography was performed at rest, after mental stress (a social stressor with a speech task), and after exercise/pharmacological stress. Summed scores of perfusion abnormalities were obtained by observer-independent software. A summed difference score, the difference between stress and rest scores, was used to quantify myocardial ischemia under both stress conditions. The Spielberger's State-Trait Anger Expression Inventory was used to assess different anger dimensions. Results The mean age was 50 years, 50% were female and 60% were non-white. After adjusting for demographic factors, smoking, coronary artery disease severity, depressive and anxiety symptoms, each interquartile range increment in state-anger score was associated with 0.36 units adjusted increase in ischemia as measured by the summed difference score (95% CI: 0.14-0.59); the corresponding association for trait-anger was 0.95 (95% CI: 0.21-1.69). Anger expression scales were not associated ischemia. None of the anger dimensions were related to ischemia during exercise/pharmacological stress. Conclusion Anger, both as an emotional state and as a personality trait, is significantly associated with propensity to develop myocardial ischemia during mental stress, but not during exercise/pharmacological stress. Patients with this psychological profile may be at increased risk for silent ischemia induced by emotional stress and this may translate into worse prognosis.

The Moderating Effect of Occupation on the Relationship between Anger and Mental Health among Extroverted and Introverted Women

“…The first hypothesis regarding aggression and their associations with women's mental health was supported that aggression was related to low level of mental health. This is consistent with the findings of previous researches [28] [29] which have shown that aggression is associated with mental illness. The second hypothesis regarding the moderating effect of occupation on the relationship between aggression and mental health was not supported.…”

Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women

“…Emotional reactivity in everyday life, as well as anxiety and depression, have been associated with myocardial ischemia during mental stress but, in general, not with exercise-induced ischemia (Boyle et al, 2013; Burg et al, 2014; Carels et al, 1999; Wei et al, 2014a). Aggressive responding, hostile affect, and trait and state anger also have been associated with MSIMI (Burg et al, 1993; Pimple et al, 2015). …”

Life psychosocial stresses and coronary artery disease

“…It has been reported that anger, both as an emotional state and as a personality trait, is significantly associated with the propensity to develop myocardial ischemia. [ 7 ] It has been shown that chest pain is more frequent in patients with Type D personality. [ 8 ]…”