title: Emotional events and anger at the workplace as triggers for a first event of the acute coronary syndrome: a case-crossover study.
abstract: BACKGROUND
  Previous studies found that some factors such as physical exertion, anger and heavy meals were triggers for acute coronary syndrome.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Negative emotional experiences and anger at work can trigger the onset of an ACS episode. This could have implications for recognizing a cardiac event as a work accident. The implementation of stress-reduction programs in the workplace or use of preventive medications in workers at high risk for coronary heart disease should be investigated.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. nestor@post.tau.ac.il
authors.forename: Nestor
authors.initials: N
authors.lastname: Lipovetzky
authors.forename: Hanoh
authors.initials: H
authors.lastname: Hod
authors.forename: Arie
authors.initials: A
authors.lastname: Roth
authors.forename: Yehezkiel
authors.initials: Y
authors.lastname: Kishon
authors.forename: Shmuel
authors.initials: S
authors.lastname: Sclarovsky
authors.forename: Manfred S
authors.initials: MS
authors.lastname: Green
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000786:Anger; D003327:Coronary Disease / Q000175:diagnosis / Q000523:psychology*; D018592:Cross-Over Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D013577:Syndrome; D017132:Workplace