Young men who quickly react to stress with anger are at three times the normal risk of developing premature heart disease, according to a Johns Hopkins study of more than 1,000 physicians.
Additionally, such men -- who said they expressed or concealed their anger, became irritable or engaged in gripe sessions -- were five times more likely than their calmer counterparts to have an early heart attack even without a family history of heart disease. Results are published in the April 22 issue of the Archives of Internal Medicine.
"In this study, hot tempers predicted disease long before other traditional risk factors like diabetes and hypertension became apparent," says Patricia P. Chang, M.D., lead author of the study and a cardiology fellow. "The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management."
Chang and colleagues analyzed data from the Johns Hopkins Precursors Study, a long-term investigation of 1,337 medical students who were enrolled at Hopkins between 1948 and 1964 and who continue to be followed. In medical school and through the follow-up period, information on family history and health behaviors has been collected.
For this report, the investigators tracked 1,055 men for an average of 36 years following medical school to examine the risk of premature and total cardiovascular disease associated with anger responses to stress during early adult life. During medical school and in 1992, all participants were given a "nervous tension" questionnaire that sought clues to how they responded to undue pressure or stress. Expressed or concealed anger, irritability and gripe sessions were the three responses defined as indicating the most anger.
Responding to the questionnaire during medical school, 229 men said they expressed or concealed their anger, 169 said they engaged in gripe sessions and 99 said they were irritable. Twenty-one men reported the highest level of anger (all three items) in response to stress.
By age 76, 205 men (35 percent) had developed cardiovascular disease, with an average onset at age 56. Of those, 145 men had coronary heart disease (94 with heart attack) and 59 reported stroke. Seventy-seven men (8 percent) had premature cardiovascular disease, with an average onset at age 49. Of those, 56 had coronary heart disease (34 with heart attack) and 13 reported premature stroke.
"Although the number of heart events was small, the incidence of cardiovascular disease was significantly higher for those with the highest level of anger compared with those with lower levels of anger," Chang says, adding that it's unclear if the findings apply to women or non-whites.
Although it's not known how anger contributes to heart disease, Chang says, evidence points to stress-related release of extra catecholamines, compounds occurring naturally in the body that serve as hormones or transmitters of messages. These substances, such as adrenaline, prepare the body to meet emergencies such as cold, fatigue and shock, by constricting blood vessels and forcing the heart to work harder to supply the body with fresh blood.
The study was supported by the National Institutes of Health and the Lucille P. Markey Foundation Charitable Trust, Palo Alto, Calif. Other authors were Daniel E. Ford, M.D., M.P.H.; Lucy A. Meoni, Sc.M.; Nae-Yuh Wang, Ph.D.; and Michael J. Klag, M.D., M.P.H. - By Karen Blum
(Reference: Chang, P. et al, "Anger in Young Men and Subsequent Premature Cardiovascular Disease: The Precursors Study," Archives of Internal Medicine, Apr. 22, 2002.)
Johns Hopkins' Welch Center for Prevention, Epidemiology and Clinical Research
American Medical Association
[Contact: Karen Blum]