Keep calm, keep fit... and carry on

By Nicole MacKee
Anger, emotional upset and intense physical exertion may trigger acute myocardial infarction (AMI) say researchers, who also found an additive effect when emotional upset and exertion were experienced concurrently.

An analysis of the INTERHEART case–control study, published in Circulation, identified 12,461 cases of AMI in mostly male (75.9%) patients with a mean age of 58.1 years.

They found that 13.6% (n=1650) of patients had engaged in heavy physical exertion in the hour before the onset of AMI symptoms, compared with 9.1% (n=1111) in the same one-hour period the day before (adjusted odds ratio [OR], 2.31). Also, 14.4% (n=1746) of patients reported anger or emotional upset before their AMI symptoms, compared with 9.9% (n=1210), the previous day (adjusted OR, 2.44). The researchers found a population attributable risk of AMI of 7.7% after physical exertion, and 8.5% after anger or emotional upset.

Patients reporting both anger and exertion before symptom onset had further increased odds of AMI (adjusted OR, 3.05), according to the analysis of the study, which included cases from 262 centres in 52 countries.

Professor Geoffrey Tofler, Professor of Preventive Cardiology at the University of Sydney and Medical Director of Heart Research Australia, said the research built on several previous studies that had identified anger and exertion as triggers for AMI, including research he conducted with colleagues in 2015 (Eur Heart J Acute Cardiovasc Care 2015; 4: 493-498).

‘What this paper adds to the literature is that the triggering effect is in a large number of people,’ he told Medicine Today. ‘It’s not restricted to one population, but includes people of various regions – Europe, Australia, America, Asia – and the results seem fairly consistent.’

The study also found that the effect was not modified by prior cardiovascular disease, cardiovascular disease risk factor burden, cardiovascular prevention medications or time of day of AMI onset.

The study reinforces the value of people looking after traditional risk factors, which will lower their absolute risk of having a heart attack at any point in time,’ he said.

Professor Tofler added that behaviour modification, such as relaxation techniques or mindfulness training, could help to moderate emotional responses in patients who were prone to intense angry reactions.

He said gaining greater understanding of how these and other triggers (e.g. respiratory infection, heavy meals and pollution) might contribute to plaque rupture, thrombosis and AMI, and how they could be modified, would be a key to future prevention efforts.
Circulation 2016; 134: 1059-1067.

Picture credit: © SPL/