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. 2015 Jan;169(1):115-21.e2.
doi: 10.1016/j.ahj.2014.07.031. Epub 2014 Sep 16.

Association between anger and mental stress-induced myocardial ischemia

Pratik Pimple  1 , Amit Shah  2 , Cherie Rooks  1 , J Douglas Bremner  3 , Jonathon Nye  4 , Ijeoma Ibeanu  1 , Nancy Murrah  1 , Lucy Shallenberger  1 , Mary Kelley  5 , Paolo Raggi  6 , Viola Vaccarino  7
Affiliations

Association between anger and mental stress-induced myocardial ischemia

Pratik Pimple et al. Am Heart J. 2015 Jan.

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: [(99m)Tc]-sestamibi single-photon emission tomography was performed at rest, after mental stress (a social stressor with a speech task) and after exercise/pharmacologic 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 IQR increment in state-anger score was associated with 0.36 U-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 with ischemia. None of the anger dimensions was related to ischemia during exercise/pharmacologic 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/pharmacologic stress. Patients with this psychologic profile may be at increased risk for silent ischemia induced by emotional stress, and this may translate into worse prognosis.

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Conflict of interest statement

Conflicts of Interest: No authors report conflict of interest.

Figures

Figure 1
Figure 1. Mental stress summed-difference scores according to state and trait anger levels
Shown are mental-stress mean SDS and standard errors according to state and trait anger score item mean levels. Numbers on bars indicate number of patients. For state-anger, categories 3 and 4 were collapsed due to limited sample size.
See this image and copyright information in PMC

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