COLUMBUS, Ohio -- People who almost always express their anger openly have one thing in common with those who usually hide it -- both groups may be putting their cardiac health at risk.
In a study just published in the International Journal of Behavioral Medicine, researchers found that middle-aged males with rigid styles of expressing anger had higher levels of both total cholesterol and "bad" cholesterol than those who were flexible about how they dealt with such feelings. People with rigid styles almost always show their anger or almost always hide it.
High levels of total and LDL cholesterol (the so-called "bad" cholesterol) have been associated with increased risk of heart disease.
"There's been a long debate in the medical community about whether it's healthier to hold your anger in or to express it outwardly. We think that's the wrong question," said Tilmer Engebretson, co-author of the new study and an assistantprofessor of psychiatry and psychology at Ohio State University.
"We found it to be harmful to always hold your anger in or always express it outwardly. The best solution is to be flexible."
Engebretson conducted the study with Catherine Stoney, an associate professor of psychology at Ohio State.
Engebretson said one limitation of the study is that it only involved middle-aged men. The 116 participants were all male airline pilots, with an average age of 42, taking part in a larger study examining the affect of personality and stress on lipid profiles.
In addition to taking cholesterol tests, the participants completed questionnaires measuring anger styles, hostility and anxiety.
People who were classified as usually showing their anger indicated that they normally lost their temper and said nasty things when they got angry. People who hid their anger reported that, when mad, they boiled inside but didn't show it and were angrier than they liked to admit.
People who were flexible in showing ire may have been angry as often as others, Engebretson said. But they reported expressing or hiding their anger about the same proportion of times.
"People who are flexible realize that in some situations it may be appropriate to show anger, but in others, it may not be," he said. "They may show their anger in front of their family, for example, but not at work. The key is to deal with each situation individually."
The researchers found that those who were flexible, but who hid their anger slightly more often than showing it, had the lowest levels of total and LDL cholesterol. Engebretson said he is unsure why these people had better scores than those who were flexible, but expressed their anger slightly more than they hid it.
All of the participants in the study had cholesterol levels that fell in the normal range, Engebretson said. The connection between anger styles and cholesterol levels may be even stronger in people with already-high cholesterol levels, although more research will be needed to confirm that.
The results of the study held up even after considering the participants' levels of hostility and anxiety, he said. This is important because some researchers have argued that other personality factors -- particularly hostility -- may be what really causes differences in heart disease risk.
"Our results suggest that it's not just hostility that affects cholesterol levels, but how a person manages that hostility and anger," he said.