Anger and the heart: perspectives on cardiac risk, mechanisms and interventions

Prog Cardiovasc Dis. 2013 May-Jun;55(6):538-47. doi: 10.1016/j.pcad.2013.03.002. Epub 2013 Apr 6.


In the popular imagination, anger has long been linked to cardiovascular diseases (CVD), but empirical validation from case-control and prospective studies emerged only in the 1970's. After describing the multidimensional nature of anger and its assessment (via self-report or observed in structured interviews), this paper selectively reviews evidence in (a) behavioral epidemiology, (b) stress and biological processes with implications for cardiopathogenesis, and (c) behavioral/pharmacological interventions for anger/hostility reduction. Although evidence is inconsistent, chronic feelings of anger, cynical distrust and antagonistic behavior are at least modestly associated with risk of both initiation and progression of CVD. Anger/hostility also is linked to stress exposure and reactivity, exaggerated autonomic function, reduced heart rate variability, platelet aggregation and inflammation. Clinical and pharmacologic treatment of anger/hostility has the potential to reduce anger and its health-damaging effects. Limitations, including third-variable explanations and overlap among the negative emotions, and implications for cardiology and behavioral medicine research and practice are discussed.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anger*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / psychology*
  • Cardiovascular Diseases / therapy
  • Female
  • Health Behavior
  • Hostility*
  • Humans
  • Male
  • Mental Health*
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology