Running While Angry

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Exercising with unusual vigor while you are enraged or emotionally distraught could be dangerous for your heart, according to a cautionary new study of the types of events that may trigger heart attacks.

The results indicate that, individually, both strenuous workouts and emotional upheaval increase the likelihood of cardiac arrest, but the risk is greatest if you combine them. The study does not prove, though, that running or otherwise sweating while mad is always inadvisable, only that some workouts and some emotions don’t mix well.

Cardiologists have long known that a wide variety of circumstances can initiate heart attacks in people with cardiac disease. Among the events that are tied to an increased risk of having a heart attack: sunrise (you’re more likely to have one on awakening), spectator sports, earthquakes, air pollution, job stress, holidays and, in rare instances, sex. Extreme physical exertion and extreme emotional distress also often have been linked to sudden heart attacks.

But many of the studies examining heart-attack triggers have been somewhat small and geographically localized, focusing on relatively few people within a single country.

The new study, which was published last week in Circulation, instead is international, relying on data about almost 12,500 men and women from 52 countries who recently had experienced their first heart attack. Part of a large, ongoing investigation of cardiac disease, this study was meant to focus on what might have set off someone’s heart attack, with particular attention being paid to people’s physical and emotional states just before they fell ill.

Since the simplest way to learn about someone’s physical and emotional state is to ask, researchers affiliated with the ongoing study visited each patient the day after his or her heart attack and went through a questionnaire that included the entries: “Were you engaged in heavy physical exertion?” and “Were you angry or emotionally upset?” The patients were asked to respond yes or no about how they had felt in the hour just before their symptoms began and also during the same hour the day before.

The researchers also completed a standard medical exam and health history of each person. Then they crunched numbers.

Heavy physical exertion and anger or emotional upset were both closely associated with an increased risk of having a heart attack, they found. About 13 percent of the people said that they had been heavily active just before their cardiac arrest, with about 14 percent saying that they had been angry or upset. There was quite a bit of overlap: Many said that they been both active and emotionally distraught before having their heart attack.

Compared to how they felt the day before the heart attack, people had about twice the risk of a heart attack when they were extremely active and about the same risk when they were feeling very emotional. Combining those states and exercising while upset tripled someone’s risk of a heart attack compared to their risk the day before.

Factoring in people’s age, general levels of physical fitness, body weight and smoking history did not change the results.

This study did not look at the physiology involved in triggering heart attacks, but both physical exertion and intense emotions can lead to “increased heart rate and blood pressure,” says Dr. Andrew Smyth, a clinician and researcher with the Population Health Research Institute at McMaster University in Canada and the lead author of the study. The consequent changes inside blood vessels can prompt plaques there to rupture, cutting off blood flow and causing the actual heart attack.

What the findings cannot tell us is what “heavy physical exertion” or “emotional upset” mean in concrete terms, since the people involved were not asked to elaborate on how they defined those phrases and were not offered any guidance by the researchers, Dr. Smyth says.

But presumably, each heart patient was conjuring memories of his or her emotions and actions the day before having a heart attack and then comparing them to those that occurred immediately before the event. So each patient would have defined heavy exertion and extreme emotion relative to his or her experience of them, Dr. Smyth says. In essence, heavy exertion for each person would represent much more activity than he or she had been engaged in the day before and more than was common for that person, Dr. Smyth says, and so, too, with emotions.

In that case, the lesson of this study, he says, is not that any kind of exercise or strong emotion may trigger a heart attack, but that workouts or feelings that are unusually lengthy or intense or somehow exceptionally strenuous, compared to what you are used to, might turn out to be triggers, he says, especially if you combine them.

Of course, no event will trigger a heart attack in someone who does not have underlying heart disease, he says. The plaques have to exist to rupture. But heart disease can be silent. If you have a family history of cardiac problems or symptoms such as shortness of breath or chest pain during exercise or after a heated argument, talk to your doctor about cardiac testing.

Otherwise, you can still use exercise to soothe emotional distress, he says, without undue concern about triggering a heart attack. Running while fuming, in other words, should generally be safe. “But stay within your normal limits,” he says. “Don’t suddenly go twice as far or twice as fast as you usually would.”