Brief periods of anger may negatively affect the ability of blood vessels to relax

Brief episodes of anger triggered by remembering past experiences may have a negative impact on blood vessels' ability to relax, which is essential for proper blood flow, says a new study published today. Journal of the American Heart Associationan open access, peer-reviewed journal of the American Heart Association.

Previous research has shown that a decrease in the ability of blood vessels to relax increases the risk of developing atherosclerosis, which may increase the risk of heart disease and stroke.

“Decreased vascular function is associated with an increased risk of heart attack and stroke,” said Daichi Shimbo, M.D., professor of medicine at Columbia University Irving Medical Center in New York City and lead author of the study. “Observational studies have linked negative emotions to heart attack and other cardiovascular disease. The most commonly studied negative emotion is anger; less research has been done on anxiety and sadness, which are also associated with heart attack risk.”

In the study, the researchers investigated whether negative emotions such as anger, sadness, and anxiety may have a more adverse effect on vascular function than neutral emotions. The 280 adults who participated in the study were randomly assigned to one of four emotional tasks for eight minutes: recalling a personal memory that made them feel angry, recalling a personal memory that made them feel anxious, reading a series of depressing passages that evoked sadness, or counting repeatedly to 100 to induce an emotionally neutral state. This protocol, “Putative Mechanisms Underlying Emotions in Myocardial Infarction (PUME),” was described by the researchers in a previous paper.

The researchers assessed the cells lining each subject's blood vessels before and at several time points after the task, looking for evidence of impaired vasodilation, increased cell damage, and/or reduced ability to repair cells. Measurements taken before the emotional task were repeated after the task was completed.

For each participant, measurements were taken at baseline (0 minutes) and at four different time points (3 minutes, 40 minutes, 70 minutes, and 100 minutes) after experiencing the assigned emotion task. Analyses revealed the following:

• When participants were asked to recall a past event that had caused anger, impaired vasodilation was observed from 0 to 40 minutes after the task. After 40 minutes, the impairment was no longer observed.
• No statistically significant changes were found in participants' vascular lining at any time point after experiencing the anxiety and sadness emotional tasks.

“We found that evoking a state of anger leads to vascular dysfunction, but the causes of these changes are still unknown,” said Shimbo. “Investigating the underlying relationship between anger and vascular dysfunction may help identify effective targets for interventions in people at high risk for cardiovascular disease.”

According to the American Heart Association's 2021 scientific statement, “Mental Health, Well-Being, and the Mind, Mind, and Body Connection,” mental well-being can positively or negatively affect a person's health and risk factors for heart disease and stroke.

“This study adds nicely to the growing evidence base that mental health can affect cardiovascular health and that intense acute emotional states such as anger and stress can lead to cardiovascular events.”

Glenn Levine, MD, FAHA, chair of the scientific statement writing committee, clinical physician and professor of medicine at Baylor College of Medicine and chief of cardiology at the Michael E. DeBakey VA Medical Center in Houston

“For example, we know that intense sadness and similar emotions are common triggers of Takatsubo cardiomyopathy. Also, stress-inducing events such as earthquakes or watching the World Cup can lead to myocardial infarction and arrhythmias. This study very eloquently shows that anger can have a negative impact on the health and function of the vascular endothelium, and we know that the inner lining of blood vessels, the endothelium, plays a key role in myocardial ischemia and atherosclerotic heart disease. Although we do not yet fully understand the mechanisms by which psychological state and health affect cardiovascular health, this study clearly brings us one step closer to elucidating such mechanisms.”

Research background and details:

• The Putative Mechanisms Underlying Myocardial Infarction Occurrence and Emotions (PUME) study is a randomized controlled experimental study conducted between August 2013 and May 2017.
• Participants were recruited from the community surrounding Columbia University Irving Medical Center in New York City.
• Participants were aged 18 years or older and in good health, which was defined in the study as having no history of heart disease, stroke, bypass surgery or stents, transient ischemic attack, peripheral arterial disease, heart failure, high blood pressure, high cholesterol, or type 2 diabetes; no self-reported diagnosis of psychiatric illness; no prescription medications or dietary supplements; and no current smokers.
• The average age of study participants was 26 years old. Approximately 50% of participants identified as female. Approximately 40% of participants identified as White adults, 29% as Hispanic/Latino adults, 19% as Asian adults, and 14% as Black adults.
• Participants' vascular health was assessed before and after completing the emotional challenge using a finger probe, which detects changes in arterial blood flow.
• Before completing the emotional task, participants were instructed to sit in a comfortable chair in a temperature-controlled room and relax for 30 minutes, during which they were not allowed to talk, use their mobile phones, read documents, or sleep.
• After participants had relaxed for 30 minutes, the researchers measured their blood pressure and corresponding heart rate with a cuff. Two blood pressure measurements were taken one minute apart to measure the dilation of the participants' blood vessels and take a blood sample for testing. Blood pressure and dilation measurements were repeated and blood samples were taken again after the assigned emotional task was completed.
• The researchers determined how poorly participants' blood vessels were able to dilate by measuring blood flow in their non-dominant forearm, assessed damage to their blood vessels by counting circulating vascular lining biomarkers in their blood, and assessed the regenerative ability of participants' blood vessel cells by measuring circulating levels of bone marrow-derived cells that are essential for repair.

Limitations of the study include that the participants were young and appeared healthy, and it is unclear whether the findings apply to older adults who may have other health problems and are likely taking medications, Shimbo said. Additionally, participants were observed in a medical setting rather than in a real-world situation, and the study only assessed the short-term effects of the emotions evoked.