Redford Williams Interview – How Anger Hurts the Heart, Part 1

Dragons At Work Chapter 1 Interview with Dr. Redford WilliamsIn Chapter 1 we see Dan Schaeffer become enraged when a truck driver refuses to pick up a love seat Dan wants to donate to charity. What is less visible is the damage his anger does to his arterial walls.

To help readers understand what’s at stake for Dan from a medical point of view, we’re fortunate to have Dr. Redford Williams educate us about how anger affects our bodies and how we can manage our stress. He’s a world renowned expert on how our emotional states and personalities affect our health.

Dr. Williams has authored or co-authored more than 200 peer-reviewed publications in scientific and medical journals. He has authored or co-authored ten books including Anger Kills, LifeSkills, and In Control. These three books draw on his well-publicized research concerning the effects of personality and behavior on health and quality of life.

Dr. Williams has been president of four leading scientific/behavioral societies: American Psychosomatic Society, Society of Behavioral Medicine, Academy of Behavioral Medicine Research, and International Society of Behavioral Medicine. He has served on several National Institutes of Health advisory groups and has received awards for his contributions as a behavioral scientist.

He received his AB at Harvard College and his MD at Yale, where he also did his internship and residency training in internal medicine. He has been at Duke University Medicine Center since 1972. He is Professor of Psychiatry, Professor of Psychology, Professor of Medicine and Director of the Behavioral Medicine Research Center.

RW: First of all, Stephen, I want to give you credit for conveying a good story of a hostile Type A personality. It’s quite plausible and it’s a great example of how some of us harm ourselves over trivial, every day things, as well as more important things. But the key thing here is it doesn’t take a lot to get a Type A personality worked up.

The first thing I noticed in this chapter is Dan doesn’t get out of his car and walk over to the driver’s side of the truck. He storms over. And he doesn’t say, “I thought you were going to pick up the love seat.” He barks it. And right off the bat, this tells us that we’re dealing with a hostile personality type. We used to call them Type A. Hostile personality is the term for the toxic part of Type A. Over the years research has shown how hostility and anger harm the heart and many other aspects of one’s health, as well as negatively impact relationships.

So Dan illustrates this hostile personality: the quick assumption that other people are screwing up, that they’re not doing their job right. Folks like Dan assume that they’re right without giving it much thought. This is the classic cynical attitude that we’ve seen over and over in people who are at high risk for heart disease.

Way back in the late fifties a group of 25 year old medical students took a personality test during their third year of medical school. We followed them up twenty-five years later and those whose scores indicated they thought other people were incompetent, that they made negative judgments about other people, that they were quick to anger and that when they got angry they didn’t bother to hide it from the object of their anger — 14 percent of them had died. Of those who were not this hostile personality type, only 2 percent had died.

In the hostile personality group the coronary rates (heart attack) were four to five times higher; but they also died of all kinds of diseases and illnesses. And research has continued to document – in both men and women — that those with Dan’s kind of personality are at high risk not only for heart disease but a whole range of other health problems, not to mention dying at an early age. Among women, those with high hostility who also try to suppress their anger are at even higher risk.

There was a study in Scandinavia that found that men with this kind of hostile personality were more likely to have an injury on the job that caused them to be out of work for more than three days. So whatever dimension of health you choose to measure, the research shows hostility is bad for you.

SJ: What’s the physiological mechanism that causes that?

RW: You’re prescient, because that’s exactly the next aspect of this story I want to address. So Dan has blown up at the truck driver. Then he’s called the Helping Hands office, used profanity and yelled at the person on the phone. Our research and that of others has shown that when men with this type of personality—this short temper, short fuse, express it, let it out, yell at people and behave aggressively—when they are angry, their adrenaline levels go up, their cortisol levels (another stress hormone) go up and their blood pressure goes up. As with heart disease risk, women with the hostile personality who try to suppress their anger have even larger blood pressure surges.

Some years ago we did a study using sophisticated techniques that measured blood flow to skeletal muscle, the muscle that enables you to fight or flee. The blood flow to the muscles in men with a high hostility level went up a lot more when they got angry than it did in men with lower levels of hostility.

SJ: Would that make them more likely to hit someone?

RW: It would prepare them to do that if they were going to. If you have to defend your cave against the other guy attacking you with his club then having a lot of blood flow to your muscles means the muscles will be able to work harder and better. Back in those early times it enabled you to survive a little bit longer and hopefully long enough to have more children and pass on your genes.

SJ: Our nervous system is the same nervous system our ancestors possessed when they padded around the savanna ten thousand years ago. This “fight or flee” response was there for very short encounters with saber-toothed tigers or human aggressors but not for saber-toothed mortgages…

RW: Or saber-toothed Helping Hand truck drivers…

SJ: Yes, and now we have an ongoing level of stress instead of quick encounters with an enemy, as in prehistoric times. We have stressors like mortgages, job security, loved ones health problems etc. and anxiety about things that might go badly in the future.

RW: Or the little old lady in front of you at the supermarket checkout line who’s taking forever to get her credit card out. In fact, the clerk has run all her items through the scanner, and she doesn’t even start to take out her credit card until he tells her how much she owes. And then she has trouble finding it. I mean, it’s enough to drive you crazy, man.

So now, here you are in a check-out line feeling agitated. And what good is it to have your adrenaline and your cortisol levels double which then causes your platelets to get stickier? After all, you’re not about to be slashed by that saber-toothed tiger!

And you’re pumping fat out from your body’s fat stores into the blood so that you’ve got energy to engage in this emergency action. Again, this response was designed to keep you alive when it was saber-toothed tigers or other cavemen attacking you. But it doesn’t do you any good when it’s a sweet little old lady who’s just taking a bit too long to get her credit card out in the supermarket.

SJ: So do the sticky platelets and the fat also lead to accretions on the artery walls?

RW: Yes. And when the blood pressure surges, it goes around corners in the heart’s left main and left anterior descending arteries where they branch out. At those branch points, when that blood pressure really shoots up, the blood flow through those arteries goes up and it actually erodes the endothelial single-cell lining of the arteries and damages them.

And that causes an inflammatory response to repair the damage. Macrophages and platelets get attracted to the damaged area to help it heal. And that’s fine if it’s just one slash from the saber-toothed tiger; but if it’s something that’s going on every day, it doesn’t heal up. The inflammatory response becomes a chronic condition which attracts more lipids (fats) because all the fat that shot out into the bloodstream doesn’t get burned up running from a saber toothed tiger. Instead, our angry modern human just stands there and fumes.

And so this unremitting stress results in the gradual build-up of arteriosclerotic plaques. Indeed, research studies show that when we put healthy young people through a laboratory stressor that’s like being in a supermarket line that’s going too slowly, and their blood pressure goes up as a result, when they were followed up ten or twelve years later, they had more calcium deposits (which are a sign of arteriosclerosis) in the coronary arteries of their heart.

This concludes Part 1 of a two part interview. For Part 2 of this interview click here.

To read Chapter 1, in which Dan becomes enraged, click here.