Fifteen years ago, at 10: 53 on a February evening, the people of Athens, Greece, were jolted by an earthquake that measured 6.7 on the Richter scale. Within an hour of the quake and for three days afterward, terrified Athenians were dropping dead at more than twice the normal rate.
This suggested, at least to Harvard School of Public Health epidemiologist Dimitrios Trichopoulos, that mental stress had triggered the increased deaths, most of them from heart attacks.
Back in 1983, when Trichopoulos published his findings in a medical journal, the notion that strong emotions could trigger a nearly-instant heart attack was anathema to many doctors, though lay people were often inclined to believe it.
Although it had been popular since the mid-'70s to think that people with hard-driving, "Type A" personalities were more prone to heart attacks than others, these early attempts to link emotions to heart disease had looked mainly at lifelong traits, not at a person's mood right before a heart attack.
But after years of focusing on long-term personality styles and chronic physical factors like high blood pressure and cholesterol, researchers are now finding considerable evidence that heart attacks can be "triggered" by immediate events as well, including powerful emotions like grief, fear and anger in the hours before an attack.
Lest merely reading about such triggers set hearts dangerously aflutter, a bit of perspective:
"We all have stressful experiences and most of us don't have heart attacks" because of them, points out David S. Krantz, a medical psychologist at the Uniformed Services University in Bethesda.
Furthermore, most people who do have a heart attack after an identifiable triggering event have underlying heart disease that puts them at higher risk, says Dr. James Muller, chief of the cardiovascular division at Deaconess Hospital in Boston.
"And even people with underlying heart disease may not be vulnerable to a trigger, including emotional stress, at any given moment," he adds.
Yet heart specialists are taking emotional triggers increasingly seriously because both mental stress and cardiovascular disease are so common. Cardiovascular disease is the No. 1 cause of death in America, killing one person every 34 seconds. About 1.5 million Americans have a heart attack every year, and a quarter of a million die before reaching a hospital.
