Blowing Off Steam Will Give You a Heart Attack?

Here’s a clue for reading health news. When you see “linked,” “associated,” or “increased risk,” your antennae should go up. The report you’re reading might be science fiction. Case in point: sloppy reports about an observational study of self-reported emotions recalled after a heart attack. Circulation published the study yesterday.

In this study, people who had a heart attack were more likely to recall having exercised and having been upset or angry at the time of their heart attack. Andrew Smyth and colleagues compared those recollections to the recollections of the same people about the day before their heart attack. They found the strongest association in people who recalled both intense exercise and anger or upset at the time of their heart attack.

Naturally, morning news shows and headlines screamed that “blowing off steam after a stressful day could be deadly.” The implication of such headlines is potentially misleading. Well-chosen physical activity is actually a pretty good way to relieve stress.

The core problem is sloppy reporting about cause and effect. The researchers correctly note that their observational study design “cannot establish causation.” Plenty of circumstantial evidence ties rage attacks to heart attacks and stroke. And concerns about excessive exertion in a state of extreme anger make perfect sense. Taking some time to chill before you exercise intensely seems like good advice.

What doesn’t make sense is the subtle suggestion that physical activity should be avoided for people with stressful lives. To the contrary, the authors of the study recommend that “clinicians should continue to advise patients about the life-long benefits of exercise.”

Beyond that, the evidence is a little thin on what to do about the link between anger and heart attacks. Glib advice to avoid extreme anger and emotional upset is fine, as far as it goes. But solid evidence for interventions to cut the risk of a heart attack is lacking.

We need better evidence to support better clinical guidance. In the meantime, tapping into resources for stress and anger management might be a good idea.

Click here for the study in Circulation and here for some background on cardiac psychology.

Working with Steam, photograph © amir / flickr

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October 12, 2016