Working with Steam

Blowing Off Steam Will Give You a Heart Attack?

my-favorite-martianHere’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

3 Responses to “Blowing Off Steam Will Give You a Heart Attack?”

  1. October 12, 2016 at 6:09 am, Joe Gitchell said:

    Thanks, Ted.

    The authors may have mentioned this, too, but not unlike a lot of the “irrelevant” studies that claim to assess smoking cessation efficacy for ecigs but surveying smokers, how does one balance out the fact that the full denominator should include those for whom it is much harder to gather a response (e.g., the poor souls who died and weren’t able to share their recollections)! It is also seems worrying that even trying to make this as an “within-person” and relying on the fidelity of that recall–a big leap.

    But I also haven’t read the whole paper so my critiques may be eminently dismissable!


    • October 12, 2016 at 8:07 am, Ted said:

      Thanks for the added insight, Joe. Pseudo-science PR can sow a lot of confusion.

  2. October 12, 2016 at 8:51 am, Madeleine Clarke said:

    I find sucking through a straw calms me down.
    Also counting to 10 (ok sometimes 15) also helps.
    I used to wake up worried and miserable…perhaps even ready for a fight when I was in the wilderness of morbid obesity.
    Now I am so so happy I have conquered the fear of losing my health and walk about with a smug smile on my face.