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Patients should avoid ‘extreme’ exercise while stressed

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People who exercise to “blow off stream” when angry or upset could triple their risk of having a heart attack if they are not careful, suggests a new large-scale international study.

The research, published in the journal Circulation, found a link between anger and emotional turmoil and the onset of myocardial infarction symptoms within one hour.

“A person who is angry or upset and wants to blow off steam should not go beyond their normal routine to extremes of activity”

Andrew Smyth

The same was true for heavy physical exertion, with more than twice the risk of people having their first heart attack, said the study authors.

In addition, patients who were angry or upset while doing a strenuous activity were at more than triple the risk, prompting the researchers to warn those who exercised when stressed not to go to “extremes”.

They looked at data from 12,461 first-time heart attack patients from the INTERHEART study encompassing 52 countries.

“Previous studies have explored these heart attack triggers. However, they had fewer participants or were completed in one country,” said lead author Dr Andrew Smyth, from McMaster University in Canada.

“This is the first study to represent so many regions of the world, including the majority of the world’s major ethnic groups,” he said.

“It’s important people know their heart attack risk and take steps to reduce their risk”

Maureen Talbot

The triggers appeared to increase the risk of myocardial infarction independently of other risk factors such as age, smoking, obesity, hypertension and other health problems, the study found.

Extreme emotional and physical triggers seem to have the same effect on the body, suggested Dr Smyth.

“Both can raise blood pressure and heart rate, changing the flow through blood vessels and reducing blood supply to the heart,” he said. “This is particularly important in blood vessels already narrowed by plaque, which could block the flow of blood leading to a heart attack.”

He said regular physical activity had many health benefits, but added: “We would recommend that a person who is angry or upset and wants to exercise to blow off steam should not go beyond their normal routine to extremes of activity.”

British Heart Foundation

Maureen Talbot

Maureen Talbot

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, said the findings were interesting, but stressed anger and emotional upset were not “underlying causes” of heart attacks.

“Heart attacks are mainly caused by atherosclerosis, the build-up of fatty plaque in the arteries. When plaque breaks off, a blood clot forms leading to a heart attack,” she said.

“That’s why it’s important people know their heart attack risk and take steps to reduce their risk, by quitting smoking, keeping physically active and maintaining a healthy weight,” she added.

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