UPFRONT | Roundup WELLNESS Exercise, anger may trigger heart attack, Canadian study finds IF YOU’RE ANGRY or upset, you might want to simmer down before heading out for an intense run or gym workout. A Canadian study ties heavy exertion while stressed or mad to a tripled risk of having a heart attack within an hour. New research led by the Population Health Research Institute at McMaster University in Hamilton, Ont., suggests there may be better or worse times to exercise, and that extremes can trigger harm. The study was published in the American Heart Association jour-nal Circulation last October. Barry Jacobs, a psychologist at the Crozer-Keystone Health System in suburban Philadelphia and an American Heart Association volunteer, said the study is further evidence of the connection be-tween mind and body. “When you’re angry, that’s not the time to go out and chop a stack of wood,” said Jacobs, who was not involved in the study. Earlier studies have looked at anger and exertion as heart at-tack triggers, but most were small or in one country, or in-cluded few women or minorities. The new study involved 12,461 people suffering a first heart at-tack in 52 countries. Their aver-age age was 58 and three-fourths were men. They answered a survey about whether they were angry or up-set, or had heavy exertion, in the hour before their heart attack or during the same time period the previous day. That way research-ers could compare risk at differ-ent times in the same people and the effect of these potential heart attack triggers. Being angry or upset doubled the risk of suffering heart attack symptoms within an hour; heavy physical exertion did the same. Having both at the same time more than tripled the risk for a heart at-tack. The risk was greatest between 6 p.m. and midnight, and was inde-pendent of other factors such as smoking, high blood pressure or obesity. Big caveats: Patients reported their own stress or anger, and peo-ple who just had a heart attack may be more prone to recall or think they suffered one of these triggers than they otherwise might have been. Also, strenuous exertion is whatever the patient perceives it to be – for some people that could be climbing stairs and for others, run-ning a marathon. The study also is observational, so it cannot prove cause and effect. But it’s likely to be the best kind of information available – it’s not pos-sible to randomly assign people to be angry and exercise, then see how many have heart attacks. “This is a large enough sample size that we can put stock in the findings,” Jacobs said. The study’s findings also are biologically plausible. Emotional stress and exertion can raise blood pressure and heart rate, change the flow of blood in the vessels and reduce the heart’s blood supply, said the study leader, Dr. Andrew Smyth of McMaster University. In an artery already clogged with plaque, a trigger could block blood flow and lead to a heart attack. “From a practical perspective, there will be times when exposure to such extremes is unavoidable,” Smyth said. “We continue to advise regular physical activity for all, including those who use exercise to relieve stress,” but people should not go beyond their usual routine at such times, he said. – Marilynn Marchione, The Associated Press PATIENT CARE Back pain patients worry about opioid stigma: survey CHICAGO – Millions of people take opioids for chronic back pain, but many of them get limited relief while experiencing side ef-fects and worrying about the stigma associated with taking them, suggests re-search presented at the Anesthesiology 2016 annual meeting. More than 100 million people in the United States suffer from chronic pain, and those with chronic low back pain are more likely than patients with other types of pain to be pre-scribed opioids. Unfortu-nately, these medications are addictive and can cause www.canadianchiropractor.ca side effects. “Patients are increasingly aware that opioids are prob-lematic, but don’t know there are alternative treat-ment options,” said Dr. Asokumar Buvanendran, lead author of the study, director of orthopedic anes-thesia and vice-chair for research at Rush University, Chicago, and vice-chair of the American Society of Anesthesiologists Commit-tee on Pain Medicine. “While some patients may benefit from opioids for severe pain for a few days after an injury, physi-cians need to wean their patients off them and use multimodal therapies in-stead,” Buvanendran added. In the study, 2,030 people with low back pain com-pleted a survey about treat-ment. Nearly half (941) were currently taking opi-oids. When asked how suc-cessful the opioids were at relieving their pain, only 13 per cent said “very success-ful.” The most common answer – given by 44 per cent – was “somewhat suc-cessful” and 31 per cent said “moderately successful.” Twelve per cent said “not successful.” Seventy-five per cent of the respondents said they experienced side effects in-cluding constipation (65 per cent), sleepiness (37 per cent), cognitive issues (32 per cent) and dependence (29 per cent). Respondents also had concerns about the stigma associated with taking opi-oids. Forty-one per cent said they felt judged for using opioids. While 68 per cent of the patients had also been treated with antide-pressants, only 19 per cent felt a stigma from using those. A major pharmaceutical company recently agreed to disclose in its promotional material that narcotic pain-killers carry serious risk of addiction and not to pro-mote opioids for unap-proved, “off-label” uses, such as long-term back pain. Researchers also note a lack of solid studies on the effectiveness of opioids in treating back pain beyond 12 weeks. – Newswise December 2016 Canadian Chiropractor 9
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