CLINICAL RESEARCH: PSYCHOLOGICAL FACTORS AND CAD
The Association of Anger and Hostility With Future Coronary Heart DiseaseA Meta-Analytic Review of Prospective Evidence
Yoichi Chida, MD, PhD* and
Andrew Steptoe, DPhil
Psychobiology Group, Department of Epidemiology and Public Health, University College London, London, United Kingdom
Manuscript received July 14, 2008;
revised manuscript received November 25, 2008,
accepted November 25, 2008.
* Reprint requests and correspondence: Dr. Yoichi Chida, Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom (Email: y.chida{at}ucl.ac.uk).
Objectives: This review aimed to evaluate the association between anger and hostility and coronary heart disease (CHD) in prospective cohort studies using quantitative methods.
Background: The harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews have been inconclusive.
Methods: We searched general bibliographic databases: MEDLINE, PsycINFO, Web of Science, and PubMed up to November 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations.
Results: There were 25 studies (21 articles) investigating CHD outcomes in initially healthy populations and 19 studies (18 articles) of samples with existing CHD. Anger and hostility were associated with increased CHD events in the healthy population studies (combined hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.05 to 1.35, p = 0.008) and with poor prognosis in the CHD population studies (HR: 1.24; 95% CI: 1.08 to 1.42, p = 0.002). There were indications of publication bias in these reports, although the fail-safe numbers were 2,020 and 750 for healthy and disease population studies, respectively. Intriguingly, the harmful effect of anger and hostility on CHD events in the healthy populations was greater in men than women. In studies of participants with CHD at baseline that controlled fully for basal disease status and treatment, the association of anger and hostility with poor prognosis persisted.
Conclusions: The current review suggests that anger and hostility are associated with CHD outcomes both in healthy and CHD populations. Besides conventional physical and pharmacological interventions, this supports the use of psychological management focusing on anger and hostility in the prevention and treatment of CHD.
Key Words: aggression CHD-prone personality hostility meta-analysis prospective study
|
Abbreviations and Acronyms
| | AX = Spielberger anger expression scale | | CHD = coronary heart disease | | CI = confidence interval | | CMHS = Cook-Medley hostility scale | | HR = hazard ratio | | MMPI = Minnesota Multiphasic Personality Inventory | | RR = relative risk | | TAS = Spielberger trait anger scale |
|
Related Articles
-
Anger, Depression, and Anxiety in Cardiac Patients: The Complexity of Individual Differences in Psychological Risk
- Johan Denollet and Susanne S. Pedersen
J. Am. Coll. Cardiol. 2009 53: 947-949.
[Full Text]
[PDF]
-
Inside This Issue
J. Am. Coll. Cardiol. 2009 53: A28.
[Full Text]
[PDF]
This article has been cited by other articles:

|
 |

|
 |
 
S. Agewall
Some Aspects of Preventing Coronary Heart Disease
Angiology,
January 1, 2012;
63(1):
17 - 23.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
J. K. Boehm, C. Peterson, M. Kivimaki, and L. D. Kubzansky
Heart health when life is satisfying: evidence from the Whitehall II cohort study
Eur. Heart J.,
November 1, 2011;
32(21):
2672 - 2677.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. D. Newman, K. W. Davidson, J. A. Shaffer, J. E. Schwartz, W. Chaplin, S. Kirkland, and D. Shimbo
Observed Hostility and the Risk of Incident Ischemic Heart Disease: A Prospective Population Study From the 1995 Canadian Nova Scotia Health Survey
J. Am. Coll. Cardiol.,
September 13, 2011;
58(12):
1222 - 1228.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. A. Whooley and J. Wong
Hostility and Cardiovascular Disease
J. Am. Coll. Cardiol.,
September 13, 2011;
58(12):
1229 - 1230.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. Burazeri and J. D. Kark
Hostility and acute coronary syndrome in a transitional post-communist Muslim country: a population-based study in Tirana, Albania
Eur J Public Health,
August 1, 2011;
21(4):
469 - 476.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. DENOLLET and V. M. CONRAADS
Type D personality and vulnerability to adverse outcomes in heart disease
Cleveland Clinic Journal of Medicine,
August 1, 2011;
78(Suppl_1):
S13 - S19.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. D. KUBZANSKY
Key 2010 publications in behavioral medicine
Cleveland Clinic Journal of Medicine,
August 1, 2011;
78(Suppl_1):
S65 - S68.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. M. Manzoni, G. Castelnuovo, and R. Proietti
Assessment of Psychosocial Risk Factors Is Missing in the 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
J. Am. Coll. Cardiol.,
April 5, 2011;
57(14):
1569 - 1570.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Steptoe
Psychosocial biomarker research: integrating social, emotional and economic factors into population studies of aging and health
Soc Cogn Affect Neurosci,
April 1, 2011;
6(2):
226 - 233.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. E. Pluss, E. Billing, C. Held, P. Henriksson, A. Kiessling, M. R. Karlsson, and H. N. Wallen
Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study
Clinical Rehabilitation,
January 1, 2011;
25(1):
79 - 87.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. D. Williams, A. Steptoe, J. C. Chambers, and J. S. Kooner
Ethnic and Gender Differences in the Relationship Between Hostility and Metabolic and Autonomic Risk Factors for Coronary Heart Disease
Psychosom Med,
January 1, 2011;
73(1):
53 - 58.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. A. Low, R. C. Thurston, and K. A. Matthews
Psychosocial Factors in the Development of Heart Disease in Women: Current Research and Future Directions
Psychosom Med,
November 1, 2010;
72(9):
842 - 854.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. R. Sutin, A. Scuteri, E. G. Lakatta, K. V. Tarasov, L. Ferrucci, P. T. Costa Jr, D. Schlessinger, M. Uda, and A. Terracciano
Trait Antagonism and the Progression of Arterial Thickening: Women With Antagonistic Traits Have Similar Carotid Arterial Thickness as Men
Hypertension,
October 1, 2010;
56(4):
617 - 622.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. B. Williams, R. S. Surwit, I. C. Siegler, A. E. Ashley-Koch, A. L. Collins, M. J. Helms, A. Georgiades, S. H. Boyle, B. H. Brummett, J. C. Barefoot, et al.
Central Nervous System Serotonin and Clustering of Hostility, Psychosocial, Metabolic, and Cardiovascular Endophenotypes in Men
Psychosom Med,
September 1, 2010;
72(7):
601 - 607.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. U. Zafar, M. Paz-Yepes, D. Shimbo, G. Vilahur, M. M. Burg, W. Chaplin, V. Fuster, K. W. Davidson, and J. J. Badimon
Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression
Eur. Heart J.,
July 1, 2010;
31(13):
1573 - 1582.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Haukkala, H. Konttinen, T. Laatikainen, I. Kawachi, and A. Uutela
Hostility, Anger Control, and Anger Expression as Predictors of Cardiovascular Disease
Psychosom Med,
July 1, 2010;
72(6):
556 - 562.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. M. Roest, E. J. Martens, J. Denollet, and P. de Jonge
Prognostic Association of Anxiety Post Myocardial Infarction With Mortality and New Cardiac Events: A Meta-Analysis
Psychosom Med,
July 1, 2010;
72(6):
563 - 569.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. M. Roest, E. J. Martens, P. de Jonge, and J. Denollet
Anxiety and Risk of Incident Coronary Heart Disease: A Meta-Analysis
J. Am. Coll. Cardiol.,
June 29, 2010;
56(1):
38 - 46.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. B. Fernandez, R. Soufer, D. Collins, A. Soufer, H. Ranjbaran, and M. M. Burg
Tendency to Angry Rumination Predicts Stress-Provoked Endothelin-1 Increase in Patients With Coronary Artery Disease
Psychosom Med,
May 1, 2010;
72(4):
348 - 353.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. de Ridder, P. Kuijpers, and H. Crijns
Lactate: panicking doctor or panicking patient?
BMJ Case Reports,
April 20, 2010;
2010(apr20_1):
bcr1020092319 - bcr1020092319.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
N. Frasure-Smith and F. Lesperance
Depression and cardiac risk: present status and future directions
Postgrad. Med. J.,
April 1, 2010;
86(1014):
193 - 196.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Y. Chida and A. Steptoe
Greater Cardiovascular Responses to Laboratory Mental Stress Are Associated With Poor Subsequent Cardiovascular Risk Status: A Meta-Analysis of Prospective Evidence
Hypertension,
April 1, 2010;
55(4):
1026 - 1032.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. Frasure-Smith and F. Lesperance
Depression and cardiac risk: present status and future directions
Heart,
February 1, 2010;
96(3):
173 - 176.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. P. Sloan, P. A. Shapiro, E. E. Gorenstein, F. A. Tager, C. E. Monk, P. S. McKinley, M. M. Myers, E. Bagiella, I. Chen, R. Steinman, et al.
Cardiac Autonomic Control and Treatment of Hostility: A Randomized Controlled Trial
Psychosom Med,
January 1, 2010;
72(1):
1 - 8.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. J. Weiss, J. Haber, J. A. Horowitz, G. W. Stuart, and B. Wolfe
The Inextricable Nature of Mental and Physical Health: Implications for Integrative Care
Journal of the American Psychiatric Nurses Association,
December 1, 2009;
15(6):
371 - 382.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
T. T. Lewis, S. A. Everson-Rose, K. Karavolos, I. Janssen, D. Wesley, and L. H. Powell
Hostility Is Associated With Visceral, But Not Subcutaneous, Fat in Middle-Aged African American and White Women
Psychosom Med,
September 1, 2009;
71(7):
733 - 740.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Denollet and S. S. Pedersen
Anger, Depression, and Anxiety in Cardiac Patients: The Complexity of Individual Differences in Psychological Risk
J. Am. Coll. Cardiol.,
March 17, 2009;
53(11):
947 - 949.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. S. Pedersen, N. Kupper, and J. Denollet
CHAPTER 35 Psychological Factors and Heart Disease
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|