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2014 ; 35
(21
): 1404-10
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Outbursts of anger as a trigger of acute cardiovascular events: a systematic
review and meta-analysis
#MMPMID24591550
Mostofsky E
; Penner EA
; Mittleman MA
Eur Heart J
2014[Jun]; 35
(21
): 1404-10
PMID24591550
show ga
AIM: Short-term psychological stress is associated with an immediate
physiological response and may be associated with a transiently higher risk of
cardiovascular events. The aim of this study was to determine whether brief
episodes of anger trigger the onset of acute myocardial infarction (MI), acute
coronary syndromes (ACS), ischaemic and haemorrhagic stroke, and ventricular
arrhythmia. METHODS AND RESULTS: We performed a systematic review of studies
evaluating whether outbursts of anger are associated with the short-term risk of
heart attacks, strokes, and disturbances in cardiac rhythm that occur in everyday
life. We performed a literature search of the CINAHL, Embase, PubMed, and
PsycINFO databases from January 1966 to June 2013 and reviewed the reference
lists of retrieved articles and included meeting abstracts and unpublished
results from experts in the field. Incidence rate ratios and 95% confidence
intervals were calculated with inverse-variance-weighted random-effect models.
The systematic review included nine independent case-crossover studies of anger
outbursts and MI/ACS (four studies), ischaemic stroke (two studies), ruptured
intracranial aneurysm (one study), and ventricular arrhythmia (two studies).
There was evidence of substantial heterogeneity between the studies (I(2) = 92.5%
for MI/ACS and 89.8% for ischaemic stroke). Despite the heterogeneity, all
studies found that, compared with other times, there was a higher rate of
cardiovascular events in the 2h following outbursts of anger. CONCLUSION: There
is a higher risk of cardiovascular events shortly after outbursts of anger.