The image of a man erupting in a fit of anger, then clutching his heart and falling to the floor may be a bit of a cliché, but there’s more truth to it than some might care to admit. Negative states like anger and stress have been linked to heart health — as they go up, heart health goes down.

A recent study finds that having an angry outburst or experiencing extreme anxiety frequently precedes a heart attack.

Researchers asked over 300 people who’d recently suffered a heart attack about their experiences and behaviors in the last 48 hours. Participants rated their anger levels over those past two days on a scale of 1-7:

    1. Calm
    2. Busy, but not hassled
    3. Mildly angry, irritated and hassled, but it does not show
    4. Moderately angry, so hassled it shows in your voice
    5. Very angry, body tense, maybe fists clenched, ready to burst
    6. Furious, forced to show it physically, almost out of control
    7. Enraged, out of control, throwing objects, hurting yourself or others.

Two of the heart attack survivors had reached an anger level of 4 within two hours of having their heart attacks, and seven patients reached a level of 5 or more within two hours. One person had reached an anger level of 5 within four hours of the heart attack. The reasons for the bouts of anger were related to arguments with family members or others, or were work- or driving-related.

After crunching the numbers, the researchers found that experiencing a bout of anger on the upper end of the spectrum was linked to an eight times greater risk of having a heart attack than not experiencing anger. Lower levels of anger didn’t show the same connection — but stress did. People who reported very high levels of anxiety also had a nine-fold greater risk of having a heart attack than less stressed participants.

It’s not totally clear why the link between anger or stress and heart problems exists, but it could be due to the increased heart rate and blood pressure that can come from an angry outburst, as well as the possibility for a plaque in the blood vessels to become loose and cause problems.

The results are still preliminary, and more research will be needed to fully understand how emotional health and physical health influence each other. But the research certainly suggests a possible, and probable, connection.

If you’re feeling irritable or lashing out, don’t wait until the next study — try some stress-reducing activities to help you deal with it. Or see a mental health professional. You and those around you will certainly benefit from a calmer you, and so may your heart.

The study was carried out by a team at the University of Sydney, and is published in the European Heart Journal: Acute Cardiovascular Care.