Be­ware ex­tremes: Ex­er­cise, anger may trig­ger heart at­tack

Malta Independent - - HEALTH - Mar­i­lynn Mar­chione AP Chief Med­i­cal Writer

If you’re an­gry or up­set, you might want to sim­mer down be­fore head­ing out for an in­tense run or gym work­out. A large, in­ter­na­tional study ties heavy ex­er­tion while stressed or mad to a tripled risk of hav­ing a heart at­tack within an hour.

Reg­u­lar ex­er­cise is a healthy an­ti­dote to stress and can help pre­vent heart dis­ease — the big­gest prob­lem is that too many peo­ple get too lit­tle of it. But the new re­search sug­gests there may be bet­ter or worse times to ex­er­cise, and that ex­tremes can trig­ger harm.

“This study is fur­ther ev­i­dence of the con­nec­tion be­tween mind and body. When you’re an­gry, that’s not the time to go out and chop a stack of wood,” said Barry Ja­cobs, a psy­chol­o­gist at the Crozer-Key­stone Health Sys­tem in sub­ur­ban Philadel­phia and an Amer­i­can Heart As­so­ci­a­tion vol­un­teer.

He had no role in the study , led by the Pop­u­la­tion Health Re­search In­sti­tute at McMaster Univer­sity in Hamilton, On­tario. Re­sults were pub­lished Mon­day in the Heart As­so­ci­a­tion jour­nal Cir­cu­la­tion.

Ear­lier stud­ies have looked at anger and ex­er­tion as heart at­tack trig­gers but most were small or in one coun­try, or in­cluded few women or mi­nori­ties. The new study in­volved 12,461 peo­ple suf­fer­ing a first heart at­tack in 52 coun­tries. Their av­er­age age was 58 and three-fourths were men.

They an­swered a sur­vey about whether they were an­gry or up­set, or had heavy ex­er­tion, in the hour be­fore their heart at­tack or dur­ing the same time pe­riod the pre­vi­ous day. That way re­searchers could com­pare risk at dif­fer­ent times in the same peo­ple and the ef­fect of these po­ten­tial heart at­tack trig­gers.

Be­ing an­gry or up­set dou­bled the risk of suf­fer­ing heart at­tack symp­toms within an hour; heavy phys­i­cal ex­er­tion did the same. Hav­ing both at the same time more than tripled the risk for a heart at­tack.

The risk was great­est be­tween 6 p.m. and mid­night, and was in­de­pen­dent of other fac­tors such as smok­ing, high blood pres­sure or obe­sity.

Big caveats: Pa­tients re­ported their own stress or anger, and peo­ple who just had a heart at­tack may be more prone to re­call or think they suf­fered one of these trig­gers than they oth­er­wise might have been. Also, stren­u­ous ex­er­tion is what­ever the pa­tient per­ceives it to be — for some peo­ple that could be climb­ing stairs and for oth­ers, run­ning a marathon.

The study also is ob­ser­va­tional, so it can­not prove cause and ef­fect. But it’s likely to be the best kind of in­for­ma­tion avail­able — it’s not pos­si­ble to ran­domly as­sign peo­ple to be an­gry and ex­er­cise, then see how many have heart at­tacks.

“This is a large enough sam­ple size that we can put stock in the find­ings,” Ja­cobs said.

“We all need to find ways of mod­i­fy­ing our emo­tional re­ac­tions and to avoid ex­treme anger,” such as dis­tract­ing our­selves, walk­ing away from the stress­ful sit­u­a­tion, try­ing to see it from a dif­fer­ent per­spec­tive, talk­ing it out and get­ting sup­port from other peo­ple, he said.

The study’s find­ings also are bi­o­log­i­cally plau­si­ble. Emo­tional stress and ex­er­tion can raise blood pres­sure and heart rate, change the flow of blood in the ves­sels and re­duce the heart’s blood sup­ply, said the study leader, Dr. An­drew Smyth of McMaster Univer­sity. In an artery al­ready clogged with plaque, a trig­ger could block blood flow and lead to a heart at­tack.

“From a prac­ti­cal per­spec­tive, there will be times when ex­po­sure to such ex­tremes is un­avoid­able,” Smyth said.

“We con­tinue to ad­vise reg­u­lar phys­i­cal ac­tiv­ity for all, in­clud­ing those who use ex­er­cise to re­lieve stress,” but peo­ple should not go be­yond their usual rou­tine at such times, he said.

The study was funded by the Cana­dian In­sti­tutes of Health Re­search, other gov­ern­men­tal bod­ies from var­i­ous coun­tries that par­tic­i­pated, and grants from sev­eral drug com­pa­nies.

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