N. Lipovetzky, H. Hod, A. Roth, Y. Kishon, S. Sclarovsky and M. S. Green
Background: Previous studies found some factors such as physical exertion, anger and heavy meals to be triggers for acute coronary syndrome.
Objectives: To estimate the relative risk of an ACS episode associated with positive and negative emotional experiences and anger as potential work-related triggers.
Methods: A total of 209 consecutive patients were interviewed a median of 2 days after a cardiac event that occurred at work or up to 2 hours later. The case-crossover design was used. Positive and negative emotional experiences and anger episodes in the hours immediately before the onset of ACS were compared with episodes in the comparable hours during the previous workday. For anger the episodes were compared with the usual frequency at work during the previous year. Positive and negative emotional experiences were assessed by the PANAS questionnaire (Positive and Negative Affect Scale), and anger by the Onset Anger Scale.
Results: The relative risks of an acute coronary event during the first hour after exposure to negative and positive emotional experiences were RR = 14.0 (95% confidence interval 1.8–106.5) and RR = 3.50 (95% CI, 0.7–16.8) respectively and RR = 9.0 (95% CI, 1.1–71) for an episode of anger. Using conditional logistic regression analysis, the highest relative risk was associated with negative emotional experiences.