Popular musician Billy Joel sings a song titled Angry Young Man that tells the story of a young man who has "never been able to learn from his mistakes, so he can not understand why his heart always breaks," and is thus destined to "go to the grave as an angry old man."

A recent study at the Johns Hopkins School of Medicine suggests that Mr. Joel‹although obviously not a doctor‹was close to the truth about heart woes when he penned Angry Young Man. The study, which tracked 1,337 male medical students for 36 years following medical school, found that students who became angry quickly under stress were three times more likely to develop premature heart disease and five times more likely to have an early heart attack. Angry young men, it appears, turn into angry old men with heart problems.

So why does this happen? Is there a correlation between anger and heart disease?

Patients are referred to Kiffer and his colleagues when their anger levels are observed by other people (a doctor or spouse), or the patients themselves recognizes that their anger or stress level is high. Kiffer says that men are more likely to act out their anger when they are stressed. This may be due to cultural factors (i.e., "boys will be boys") and their tendency to want to fix or change circumstances. Unfortunately, many men do not recognize this connection between stress and anger until they have a wakeup call‹such as a heart attack.

But how can anger lead to a heart attack? "When you are angry, your body reacts as though it is under attack," says Kiffer. "It is all systems go as you get a rush of adrenaline and your body revs up preparing to defend itself.

"But in today's world, you can not go out and attack someone every time you get angry, so your body has all of this pent-up energy and stress. It is equivalent to sitting at a red light with your foot on the brake and the gas pedal floored. Your tires start spinning and your car is all revved up with no place to go. The same thing happens in your body when you get angry and don't have an outlet for your anger, only the problem is what is spinning and burning is inside your nervous system."

Kiffer further notes that when you get angry, your body releases cholesterol and an array of chemicals called catecholamines into your blood stream. People who are hostile or angry have advanced levels of catecholamines in their systems, and research has shown that these chemicals actually speed the development of fatty deposits in the heart and carotid arteries.

"If you are mad at the world and you have a family history of heart disease, you are loading the bullets in the gun and pulling the trigger at an early age without realizing it," says Kiffer. "People with a strong family history need to recognize that anger can be a strong risk factor. In fact, some research has shown that anger can be just as much of a risk factor for heart disease as smoking, obesity and lack of exercise."

So does this mean that the young man (or woman) with the classic "Type A" personality is destined to die of a heart attack. Not necessarily. That is because the old notion of a "Type A" personality was someone who was angry, outspoken and always on the go. Kiffer notes that it is okay to be busy and always on the go, but anger, hostility and a cynical attitude are not good for your heart health.

Kiffer points out that psychologists now consider "Type A" people to be "hot reactors." "If you are a "hot reactor," that means it does not take much for people to push your buttons, and you react fiercely and quickly."

But even "hot reactors" can learn to manage their anger. "The popular belief is that if you are angry you need to get those feelings out and get them off your chest," points out Kiffer. "But if you express your anger, it can snowball. If you get in a gripe session and other people confirm your anger, your anger level could actually increase because other people confirm your feelings and you feel like you have a right to be angry. Now you are self-riotously angry."

Yet holding anger in does nothing to relieve stress. In fact, Kiffer likens it to shaking a 2-liter bottle of pop with the cap on. Sooner or later the pop bottle will explode, and so will you‹probably in the form of a heart attack or some other ailment.

"It is a delicate balance," explains Kiffer. "The best remedy is to not get angry in the first place. Try to develop a longer fuse. If you can not do that, then acknowledge your anger and take constructive action to try and change the situation that is making you angry. If you take some action, and the situation can not be resolved, then accept that fact and let it go."