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When you’re all worked up, a workout may help you blow off steam. But a new study suggests that exercising to extremes when you’re angry may be hard on your heart.

Researchers analyzed data from more than 12,000 heart-attack patients in 52 countries to document the connection between emotional distress, physical exertion, and cardiac-arrest symptoms. Participants completed questionnaires about their activities and emotional state in the hour before their heart attack.

The results, published in the American Heart Association’s Circulation, show that being angry or upset more than doubled a patient’s risk of having a heart attack within an hour. The odds tripled for hot-tempered patients who engaged in self-defined “heavy physical exertion.” The study noted that these triggers independently increased the risk of heart attack beyond those posed by other factors, such as age, smoking, obesity, and high blood pressure.

Lead author Andrew Smyth, PhD, of Ontario’s McMaster University, notes that both physical exertion and anger or emotional upset can cause a surge of systematic vascular constriction as well as increased heart rate and blood pressure. These effects can block blood flow in vessels already narrowed by atherosclerotic plaque.

Smyth emphasizes that regular exercise can help prevent heart disease. “However,” he adds, “we would recommend that a person who is angry or upset who wants to exercise to blow off steam not go beyond their normal routine to extremes of activity.”

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