Anger May Increase Stroke Risk Through Impaired Vasodilation
The observed relationship between the provocation of negative emotion and increased risk of cardiovascular disease events, including stroke, may be attributed to adverse effects on endothelial cell (EC) health, according to results of a study published in the Journal of the American Heart Association. Provoked anger in particular was found to be associated with impaired endothelium-dependent vasodilation (EDV), while provoked sadness and provoked anxiety had no statistically significant effect on EC health.
In the PUME study (NCT01909895), researchers employed a randomized controlled experimental design, dividing a participation population of 280 healthy, non-smoking individuals aged ≥18 years into 4 groups: anger induction (n=72), anxiety induction (n=72), sadness induction (n=69), and neutral condition (n=69). Participants in the anger and anxiety induction groups engaged in a recall induction technique, asked to discuss either an anger- or anxiety-provoking personal memory for 8 minutes. Participants in the sadness induction group underwent the Velten mood induction technique, reading descriptors designed to evoke sadness for 8 minutes. The neutral condition group counted from 1 to 100 aloud for 8 minutes. According to Visual Analog Scale (VAS) ratings, individuals in the anger, sadness, and anxiety groups showed the greatest increase of their respective intended emotion, suggesting high fidelity for the employed emotion induction techniques.
EDV, EC injury, and EC reparative capacity (as defined by reactive hyperemia index [RHI], circulating endothelial microparticles [EMPs], and circulating endothelial progenitor cells [EPCs], respectively) were measured at baseline and at intervals up to 100 minutes postinduction of emotion. As compared to individuals in the neutral condition group, EDV was found to decrease significantly for individuals in the anger induction group, with the greatest effect observed at 40 minutes postinduction. After 40 minutes, there was no observed EDV impairment. Significant EDV impairment was not observed for the sadness or anxiety induction groups. Adjustments for VAS rating had no effect on the observed results, indicating that the EDV impairment associated with anger was not influenced by nonspecific increases in anxiety or sadness. Finally, there were no observed changes in EC injury or EC reparative capacity for any of the induction groups.
The study findings suggest that certain emotions, such as anger, may have different physiological effects compared to other emotions. Daichi Shimbo, MD, Study Author and Professor at Columbia University states, “I think that tells you that maybe we shouldn’t put all these negative emotions into one bucket.”