CLINICAL STUDY: CORONARY ARTERY DISEASE
Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis
Peter Angerer, MD*,
Uwe Siebert, MD, MPH ,
Wolfgang Kothny, MD*,
Dagmar Mühlbauer, MD*,
Harald Mudra, MD* and
Clemens von Schacky, MD*
* Medizinische Klinik der Universität München–Innenstadt, München, Munich, Germany
Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Universität München–Grosshadern, Munich, Germany; presently at the Harvard Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts
Manuscript received July 26, 1999;
revised manuscript received April 21, 2000,
accepted June 28, 2000.
Reprint requests and correspondence: Dr. Peter Angerer, Medizinische Klinik, Klinikum Innenstadt der Universität München, Ziemssenstrasse 1, D-80336, Munich, Germany.
pangerer{at}medinn.med.uni-muenchen.de
OBJECTIVES
This prospective cohort study of patients with coronary artery disease (CAD) sought to determine the impact of social support, anger expression and cynical hostility on progression of coronary atherosclerosis as shown by angiography.
BACKGROUND
Low social support, high levels of expressed anger and cynical hostility are correlated to increased CAD morbidity and mortality. However, the impact of these factors, alone or together, on progression of human coronary atherosclerosis is unknown.
METHODS
Of 223 patients with CAD documented by standardized angiography at baseline, 162 had a second angiogram after two years. An expert panel who had no knowledge of the patients’ characteristics evaluated the films pairwise to determine disease progression. At baseline, all patients were asked to answer three self-report questionnaires: questions concerning emotional social support, the State-Trait-Anger-Expression Inventory (STAXI) and the Cook-Medley cynical hostility scale. Each patient’s clinical and laboratory status was followed.
RESULTS
Questionnaires and angiographic follow-up data were available for 150 patients. Bivariate analysis of the psychological variables showed a higher risk of progression only for patients who scored high on STAXI anger-out or low on social support. In the multivariate analysis, when adjusting for confounding variables and examining the interaction between psychological variables, only patients with both high anger-out and low social support were at highly increased risk for progression (odds ratio 30, confidence interval [CI] 5.5 to 165.1; RR 3.19).
CONCLUSIONS
Patients with CAD and low emotional social support who express anger outwardly are at a highly increased risk of disease progression, independent of medication or other risk factors.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CI | = confidence interval | | ECG | = electrocardiogram or electrocardiographic | | HDL | = high density lipoprotein | | LDL | = low density lipoprotein | | OR | = odds ratio | | PTCA | = percutaneous transluminal coronary angioplasty | | RR | = risk ratio | | SCIMO | = Study on prevention of Coronary atherosclerosis by Intervention with Marine Omega-3 fatty acids | | STAXI | = State-Trait-Anger-Expression Inventory |
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