The old adage says it's good to work out your emotions through exercise, but a new study suggests you steer clear of this advice if the emotion you’re looking to work out is anger. The report from McMaster University in Canada found that intense physical exertion and extreme emotional upset can both trigger a heart attack, and the risk may be even greater when the two are combined.

Data on 12,000 heart attack cases in 52 countries revealed that 14 percent of patients had been engaged in heavy physical exertion prior to their heart attack and 14 percent were very anger or emotionally upset an hour prior to their first heart attack, Reuters reported. What’s more, physical exertion and anger or emotional upset were identified as first heart attack triggers in all regions of the world regardless of gender or age.

“Our study is the largest study exploring this issue, and unlike previous studies we included people from many different countries and ethnicities,” lead author Andrew Smyth told Reuters.

Although the researchers did not specifically define “upset” or “physical exertion,” which left the interpretation up to the respondents, the results do help us better under and potentially prevent, heart attacks. According to the American Heart Association, a heart attack can occur when blood flow that brings oxygen to the heart is either extremely reduced or completely cut off. When the heart doesn’t receive oxygen for a period of time it can lead to permanent damage or even death to part of the heart muscle.

In addition to avoiding extreme strenuous activity and emotions, research has also shown that other lifestyle adjustments such as reducing alcohol consumption, not smoking, and reducing the amount of belly fat can also help to lower one's risk.

Source: Smyth A, O’Donnell M, Lamelas P, Teo K, Rangarajan S, Yusuf S. Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial Infarction. Circulation.

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