Ask Doctor K by Anthony Komaroff

LEARNING TO CONTROL ANGER WILL HELP YOU AVOID HEART TROUBLE

DEAR DOCTOR K: I have a bad temper. Could my anger trigger a heart attack?

DEAR READER: You've seen it in movies: A character shouts in anger -- then drops to the floor clutching his chest. But this isn't just a movie scenario. Research shows that in the two hours after an angry outburst, a person has a slightly higher risk of having heart trouble. By heart trouble, I mean chest pain (angina), a heart attack, or a dangerous heart rhythm that can lead to sudden death. The person also is at higher risk for having a stroke.

How does a surge of anger increase your risk for heart trouble or a stroke? I spoke to my colleague Dr. Murray A. Mittleman, an associate professor of medicine at Harvard Medical School, about how anger can trigger heart trouble. He explained that anger causes an outpouring of stress hormones. These hormones make your heart beat faster and your blood pressure rise. They also make your blood more likely to clot.

The risk that any particular surge of anger will cause heart trouble or a stroke is small, but it's real. And it's much higher in people who have heart disease. Unfortunately, many people who have heart disease don't know it. About 80 percent of people who have sudden death occurring outside the hospital did not know that they had heart disease.

So if you know you have heart disease, or risk factors for heart disease, it's particularly important to avoid situations that might cause you to be angry. I know that's easier said than done -- but it can be done. Sometimes you need to make decisions that you don't want to make, such as looking for a new job if it's making you constantly angry.

You also need to learn how to control your anger. On my website, AskDoctorK.com, I've put a brief questionnaire to help rate your anger level.

To better control your anger, consider an anger management program. Such programs help people tone down their anger, respond to threatening situations less aggressively and use positive behavior strategies. It remains to be proven that anger management can reduce heart trouble and strokes. However, I'll bet it does.

Other strategies for keeping anger at bay include the following:

-- RELAX. In the heat of the moment, try to step back and take some deep breaths.

-- REFRAME YOUR THINKING. When angry, people tend to exaggerate.

-- COMMUNICATE WITH CARE. During an argument, slow down. Listen carefully to what the other person is saying and stop to think before responding.

-- CHANGE YOUR ENVIRONMENT. When your immediate surroundings trigger rage, move away if possible. Don't try to get back at whoever or whatever is making you angry. Just walk away.

Medication may also help. Limited evidence suggests that beta blockers, which slow the heart rate and control blood pressure, may lessen the effect of anger on the heart. And antidepressant drugs known as SSRIs may reduce the frequency of angry outbursts and help you better control your impulses.