New study: bouts of anger can take a toll on your heart

June 20, 2024

Swedish Health Team

[5 min read]

Frequent episodes of anger can impair vascular function and increase the chances of heart attack or stroke.
The research is the first to directly link anger and life-threatening vascular impairment.
Experts from Swedish Behavioral Health and Wellbeing and the Swedish Heart and Vascular Institute explain the new study and offer tips to manage your emotions and your cardiac health.

Has something ever made you so mad that it made your blood boil? If you’re someone whose temper flares regularly, it could be dangerous to your health. A recent National Institutes of Health (NIH)-funded study demonstrated that anger, particularly long-term anger, can damage blood vessels and increase your risk of heart attack or stroke. The study, published in the Journal of the American Heart Association, was the first of its kind to directly link anger to life-threatening vascular impairment.

To learn more about the findings, what they mean for your cardiac health and how you can manage your feelings of frustration and anger, we spoke with two of our Swedish experts: Sarah M. Speck, M.D. MPH, medical director of cardiac rehabilitation and wellness at the Swedish Heart and Vascular Institute, and Ash Choi, a psychotherapist with Swedish Behavioral Health and Wellbeing.

We all get angry. When is it dangerous? How does anger affect our body?

Ash Choi: Anger is a human emotion and one that is absolutely normal. When we can be in tune with our emotions, anger can actually help us identify problems, protect ourselves from things that are hurting us or threatening our safety, motivate us to push for change, and help us stand up against injustice. Chronic anger, however, can have detrimental impacts on our quality of life, relationships, and physical wellness. Negative emotions are a part of the human experience and there is still a tremendous amount of research that still needs to be done to measure their true impact on physical health. We need to pay attention to when those negative emotions start to impair multiple areas of our lives, such as work, school, relationships, physical health, and mental health.

Dr. Speck: We have known from [other] observational studies that heart attacks can be precipitated by negative emotions, including anger, and that this increases the risk of future heart attacks and strokes. Atherosclerosis, the disease process most commonly associated with heart attacks and strokes, involves inflammation of the lining of the blood vessels called the endothelium and the smooth muscle that surrounds the area through which the blood flows. The body’s ability to constrict blood vessels can be lifesaving in the presence of hemorrhage or circulatory shock, but abnormal constriction of blood vessels can have more serious consequences, including damage to the blood vessels and the heart muscle itself. It can alter the internal architecture of the blood vessel walls and can increase the heart’s workload by elevating the resistance against which the heart pumps. Such an abnormal reaction in a person with atherosclerotic plaque in their blood vessels could potentially be even more consequential both in the moment of an initial anger episode or with repeated episodes. This study has demonstrated that even in younger people with healthy blood vessels who are experiencing anger — and who have none of the usual cardiac risk factors — have constricted the blood vessels for a measurable period of time, as long as 40 minutes after the anger subsides. Further studies will be needed to explore this.

Anger is a human emotion and one that is absolutely normal. When we can be in tune with our emotions, anger can actually help us identify problems, protect ourselves from things that are hurting us or threatening our safety, motivate us to push for change, and help us stand up against injustice. Chronic anger, however, can have detrimental impacts on our quality of life, relationships, and physical wellness.

What are some practices we can institute in our daily lives to help us manage feelings of anger and lower their intensity?

Dr. Speck: Stress is ubiquitous and to experience anger is to be human. Moving the larger muscle groups in our body can reduce the level of stress hormones generated in our body. Regular moderate movement/exercise such as dancing, walking, swimming all will reduce the adverse biochemical effect of those stress hormones by using them up while doing those activities. The other piece is to build stress resilience with a regular practice of meditation, mindfulness, yoga or Tai Chi. These activities increase the level of “anti-stress” or relaxing hormones in our body and neutralize the potentially harmful effects of biochemical change provoked during episodes of anger and stress. Even 10 minutes a day is an investment in your health that will grow over time.

Ash Choi: While some schools of thought recommend high intensity exercise as a way to help prevent potentially destructive or harmful behaviors (which can be precipitated by anger) or lower heightened emotions, research suggests that lowering the intensity of physical arousal slows our heart rate; this allows the rest of our physiological systems to come back to homeostatic state. There are many practical skills we can use to “deactivate” our nervous system. Engaging in relaxation exercises, meditation, stretching, yoga, and deep breathing. Breathing exercises that emphasize a longer exhale have been proven to lower heart rate. Try this calming exercise: slowly breathe in for a four-count, hold for a two-count, exhale for a six-count, hold for a two-count, repeat.

Do you have other recommendations for balanced and healthy bodies and minds?

Ash Choi: Remember that we all have moments of losing our tempers. Generally speaking, we tend to find things that help bring us back down, whether that’s talking ourselves down, apologizing to others, slowing down our breathing, etc. Another thing to remember is that certain skills don’t always work [in every situation]! If a deep breathing exercise doesn’t seem to be effective, for instance, you might try going for a slow walk outside and observing things you see, hear, smell, touch, or taste. If you find yourself in a car or any other place where you can’t move into a different space, singing along to the radio can actually force us to re-regulate our breathing and distract ourselves from our own thoughts.

Dr. Speck: A healthy diet, regular exercise and managing stress in our life all improve the health of our blood vessels, reducing blood vessel inflammation and lowering the risk of heart disease and stroke long term. Dr. Dean Ornish was able to prove that a plant-based diet, daily moderate exercise, and a regular practice of meditation and yoga reduced and, in some cases, reversed the buildup of plaque in heart arteries. The Mediterranean diet incorporating fish and plant-based foods has also been proven to reduce heart attacks and strokes in people, even in those who have already experienced one. It’s important to do our best and maintain these healthy habits and behaviors throughout our life.

Learn more and find a physician or advanced practice clinician (APC)

If you have questions about behavioral health services, Swedish is here for you. Contact Swedish Behavioral Health and Well-Being. We can accommodate both in-person and virtual visits.

Call 206-320-4100 to learn more or make an appointment with a specialist at the Swedish Heart & Vascular Institute. You can can find additional information about the advanced heart treatments and services available at Providence Swedish by visiting Swedish.org/heartcare.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.

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