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Mostofsky E, Penner EA et al. Eur Heart J 2014; 10.1093/eurheartj/ehu033

It has long been held that anger is associated with a higher risk of myocardial infarction, acute coronary syndrome, ischaemic and haemorrhagic stroke and arrhythmia. However, this had been based on studies with only small sample sizes. This systematic review identified nine case-crossover studies. The investigators report that in the two hours following an outburst of anger, subjects with a 'higher baseline cardiovascular risk and individuals who have frequent outbursts of anger' were five times more likely to have a heart attack and three times more likely to have a stroke. However, a small outburst of anger is trivial in the low risk population, in that there was only one extra cardiovascular event per 10,000 subjects each year. There was some heterogeneity between the studies, and there could be reverse causation in that the cardiovascular event could have precipitated an anger outburst. In addition to psychosocial interventions, the taking of medications such as beta-blockers, aspirin, calcium antagonists, or nitrates may lower the risk from outbursts of anger.