Emotional triggers in myocardial infarction: do they matter?

Abstract

Considerable excitement and interest have arisen recently concerning the role that acute emotional triggers may play in precipitating a myocardial infarction (MI). Observational studies have found repeatedly that patients report excessive anger, anxiety, sadness, grief, or acute stress immediately prior to onset of MI, and recent meta-analyses summarizing these findings reported strong associations between MI occurrence and many of these acute emotions. However, it is unclear whether and through what mechanisms acute emotional triggers might influence MI, and whether there is any clinical utility in knowing if or how emotions trigger MI. We debate whether emotional triggers matter by reviewing the recent evidence for the association between acute emotional triggers and MI and by describing the potential pathophysiological characteristics and mechanisms underlying this association and the preventive strategies that could be used to mitigate the risk of acute MI. We also examine whether the study of emotional triggers could influence clinical risk management or changes in clinical practice/management. We offer suggestions for research that might shed light on whether emotional triggers could initiate a paradigm shift in preventive cardiology, or whether acute emotional triggers are either intractable catalysts for, or merely an epiphenomenon of, some MIs.

Figure 1

Associations of four emotional triggers and occurrence of acute myocardial infarction^a. ^aData are taken from Nawrot et al. ^bBars indicate 95% confidence intervals.

Figure 2

Theoretical model of the interaction of baseline risk of cardiovascular disease and intensity of acute emotion on triggering of acute myocardial infarction. FRS, Framingham risk score; MI, myocardial infarction.