Here’s another reason to keep your emotions and physical activities in check: You may trigger a heart attack.

In a large international study published Monday in the American Heart Association journal Circulation:

  • Angry/emotionally upset participants had more than twice the risk of the onset of heart attack symptoms within one hour.
  • The same was true for heavy physical exertion during the hour before their first heart attack.
  • The risk was three times higher for those who were angry or emotionally upset while also engaging in heavy physical exertion.

“This large, nearly worldwide study provides more evidence of the crucial link between mind and body,” said Barry J. Jacobs, Psy.D., director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania.

For the study, 12,461 first-ever heart attack patients in 52 countries completed a questionnaire about whether they experienced any of the triggers in the hour before their heart attack. They were also asked if they had experienced any of the triggers in the same hour on the day before their heart attack.

The triggers appeared to independently increase their heart attack risk beyond that posed by other risk factors, including age, smoking, obesity, high blood pressure and other health problems.

“Both (extreme emotional and physical triggers) can raise blood pressure and heart rate, changing the flow of blood through blood vessels and reducing blood supply to the heart,” said Andrew Smyth, M.D., Ph.D., study lead author and a researcher at the Population Health Research Institute at McMaster University in Canada and at the HRB Clinical Research Facility in Galway, Ireland.  “This is particularly important in blood vessels already narrowed by plaque, which could block the flow of blood leading to a heart attack.

“Regular physical activity has many health benefits, including the prevention of heart disease, so we want that to continue. However, 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.”

The triggers appear to have the same effect across countries and ethnicities.

“People who are at risk for a heart attack would do best to avoid extreme emotional situations,” Jacobs said. “One way many cope with the emotional ups and downs of a health condition is through peer support, talking with others who are facing similar challenges.”