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The Angry Heart
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— February 16, 2015

The Angry Heart

By Lisa James
  • Feeling frustrated and hostile all the time is hard on your cardiovascular health.
The Angry Heart

You can’t see anything but a red line of brake lights when suddenly a blur whips in from the right—and you hit your brakes to avoid slamming into the interloper’s back end. “Idiot,” you scream, gesturing out the window. Then you mutter, “Probably one of the people from that new development.” Just thinking about all those extra cars jamming the roads can set you ranting to your wife for five minutes (not that she’d ever listen).

It doesn’t get any easier at the office. “Late again?” your boss asks. When you try to explain he cuts you off, saying, “That’s not my problem. Leave earlier.” You turn away but inwardly you’re seething; doesn’t he realize how difficult your commute has become? And when you finally get to your desk you’re greeted with at least three dozen new emails, five of which have attention flags. “What’s wrong with these impatient fools…” 

Everyone has crazy-making days and even normally placid people may respond with the occasional outburst. But others work themselves into an indignant lather over and over again.

At that point anger can morph into hostility, which has three aspects: “Cynical mistrust of other people, increased tendency to get angry at others and an increased tendency to express that anger—yelling, honking the horn,” says Redford Williams, MD, director of the Behavioral Medicine Research Center at Duke University Medical Center in Durham, North Carolina, and author (with his wife Virginia) of Anger Kills (Harper Paperbacks). That’s when getting angry is “like taking a dose of some slow-working poison every day of your life.”

“Anger is one of the most stressful emotions we ever experience,” says Howard Martin, executive vice president of HeartMath (, a California company that helps people overcome the effects of negative emotions. He says that when anger arises, “we throw our heart rhythms into chaos.” 

That sort of cardiac chaos can be hazardous. “In one study people who were angry as freshmen were, 25 years later, more likely to be overweight and not exercising enough; they also had larger responses in terms of heart rate, stress hormones and blood pressure,” says Williams. “In studies people with high hostility levels have platelets that are more likely to clot. All of these physiological changes increase the development of atherosclerosis, particularly in younger age groups.”

Doing Damage

Physicians are well aware of how anger and stress can affect well-being. “Many times I’ve asked cardiologists, ‘What is the major cause of heart disease?’” says Martin. “I expected them to say diet and not enough exercise but they said that between 80% and 90% of the time it’s stress, not just anger but any strong negative emotion.”
However, as Williams puts it, “Anger all by itself can’t do anything to your heart. It has to work through biological and behavioral pathways.”

One Nation, Under Stress
Not surprisingly, stress feeds not only anger but also fear, anxiety and other negative emotional states. And no doubt about it—Americans are a stressed-out bunch.
According to the American Psychological Association’s most recent Stress in America survey:

said their stress level has increased

felt irritable or angry in the previous month

felt nervous or anxious

said managing stress was “extremely” or “very” important

were doing something about it

For one thing, “it’s obvious that when we’re highly stressed we tend to eat differently,” says Martin. “That explains comfort food; people are looking for satisfaction because their lives aren’t satisfying.” Williams adds that hostile people are more likely to smoke and use alcohol.

But anger’s effects go beyond harmful behavior. It “puts a tremendous amount of wear and tear on the autonomic nervous system,” the part that controls functions such as respiration, notes Martin. “We flood our systems with hormones in amounts that are not good for us.” Those hormones, primarily adrenaline and cortisol, cause the heart to pound and both blood pressure and glucose levels to rise. While such responses are necessary in life-or-death situations, the sorts of daily frustrations most people face—like traffic jams—can prolong this stress response, setting the stage for such cardiovascular dangers as obesity, diabetes and hypertension.

What’s more, “the heart is an information-processing system,” write HeartMath founder Doc Childre and Deborah Rozman, PhD, in Transforming Anger (New Harbinger). “Your heart’s beat-to-beat rhythmic pattern, called heart rate variability or HRV, is very sensitive to your changing emotional states.” Stressful emotions cause “an incoherent HRV pattern,” putting extra strain on the body.

Such disruptions can cause life-threatening arrhythmias. In a study presented before the American Heart Association, being moderately angry tripled arrhythmia risk among people who had implanted defibrillators (devices that shock the heart back into a normal rhythm). In a large Canadian study, hostile people were significantly more likely to develop coronary artery disease (Journal of the American College of Cardiology 9/13/11). Women may be especially at jeopardy. In research presented to the American Psychosomatic Society, women whose smaller coronary arteries were diseased responded strongly to emotional stress.

Quick on the Trigger

So why do some people react to irksome situations with rage while others respond with a shrug? “It’s a question of personality type,” says Williams. “It’s not the genes or the environment, but the genes and the environment.”

The roots of chronic hostility run deep. Williams says some people have a genetic quirk that leaves them anger-prone. In addition, he says, “Research shows that people who are exposed to mistreatment during childhood are more likely to have problems with violent behavior when they grow up, men in particular.”

Children can end up modeling a parent’s angry behavior even if no mistreatment is involved. Martin says his father “had a quick temper. He was a good father but I watched this pattern of tension and relief his entire life; he died of a heart attack at age 67. In my early life I had the same sort of characteristics.” One study found heart rate changes in children as young as six months old who were exposed to anger (Journal of Child Psychology and Psychiatry 11/09).

Constant ire causes changes within the brain. “When we find ourselves getting angry over and over again, that neural pathway gets stronger,” Martin explains.

It doesn’t help to live in a society in which the terms “road rage” and “flame wars” have become a part of the lexicon and internet comment sections often degenerate into name-calling virtual slugfests.

“It’s like the water we’re swimming in. Fish swimming in polluted water don’t know the difference until they are introduced to fresh water,” says Martin. “Judgmentalism is endemic because that’s the way society in general functions.”

Change is possible, however, no matter what has happened in the past or is happening in the present. “We can’t continually excuse ourselves because of society’s issues,” Martin says. “We have to take self-responsibility at some point.”

Positive Awareness

The first step in overcoming anger—or any other strong negative emotion—is to become aware that one has a choice of responses.

Martin calls it “the emotional diet, the emotions we run through our systems day after day. If I want to be angry, frustrated, resentful, I have a choice; I can do that. But it’s like if I decide to eat nothing but chocolate cake for a week—my body is going to react.”

Sometimes the body’s unhealthy reaction sets people up for change. “One of the things about disease is that when people get sick they begin to reevaluate things,” says Martin, coauthor with Childre of The HeartMath Solution (HarperOne). “Once you have that sincere desire there are resources—books, webinars, training programs. Things like breathing exercises, meditation, stuff like that, can be helpful in bringing people to a state of balance within themselves.”

Williams gives the example of a woman who wants to see a Julia Roberts movie but her boyfriend says, “You’re stupid—all you want to watch are chick flicks.” He says the woman’s first step should be to evaluate her angry response: “Can I get him to stop telling me I’m stupid? Is it worth it for me to tell him to stop that? Maybe I think he’s nice in so many other ways that I can ignore this incident.” Williams says that if the woman does respond, the idea is to be assertive, not aggressive: “You know it causes me to feel hurt when you say that. Can you not use words like ‘stupid’ when I suggest a Julia Roberts movie?”

To teach people assertiveness and other ways of dealing with negative emotions, Williams and his wife have started a training company, Williams LifeSkills ( “What we have found is that people getting this training have reduced anger and depression, more social support and fewer changes in heart rate and blood pressure,” he says, adding, “Look for ways to inject positivity into your encounters with other people.”

HeartMath provides training, including apps and desktop technology, that helps people change their heart rate variability to promote coherence. “Researchers have found that tools and techniques that allow you to shift your heart rhythm into a more coherent pattern enable the brain to find a match to a more positive feeling,” write Childre and Rozman.

Anger wasn’t Byron Smith’s problem. But he has found HeartMath helpful in dealing with a series of challenges that left him feeling anxious.

Smith, 53, of Austin, Texas, had returned home from a long, stressful tour as the drummer in a musical group called The Pictures Band when he was diagnosed with prostate cancer and underwent surgery. “As I was trying to recover, to get back on my feet, big fires occurred around here,” he recalls. “The Lost Pines Forest burned: over a million trees, along with 1,700 homes. I lost every single thing—it was burnt to the ground. The worst part was my dogs passing away, that was the most painful thing.”

Smith’s parents had died shortly before that. To compound his troubles, his wife left after the fire.

What’s more, years ago Smith came face-to-face with a girlfriend’s kidnapper. “The kidnapper had me on the ground with a gun to my head, saying he’d kill me first,” he says. “I think I had some PTSD even before the fire. So when the fire occurred, I was a wreck.

“I started doing HeartMath about two years ago along with Bikram yoga,” which is done in a room heated to 105 degrees. “In Bikram it’s easy to start mouth-breathing and panic,” Smith says. “When I learned how to apply some of the HeartMath concepts, like paying attention to what state I was in, it allowed me to do a better job at the yoga.”

Now Smith, who also lost 30 pounds on the Paleo diet, says, “I’m happier and healthier than I ever was before. I feel like I’m on the right track.”

“Kindness, compassion: If you focus on these things your emotional appetite actually changes,” says Martin. “Focusing on the positive side of things is definitely good for people.”

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