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Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
March
9, 2009
Anger and Hostility Harmful to the Heart, Especially Among
Men
Management of psychological stressors may be
important strategy for prevention and treatment
Anger and hostility are significantly associated with both
a higher risk for coronary heart disease (CHD) in healthy
individuals and poorer outcomes in patients with existing
heart disease, according to the first quantitative review
and meta-analysis of related studies, which appears in the
March 17, 2009, issue of the Journal of the American College
of Cardiology. Management of anger and hostility may
be an important adjuvant strategy in preventing CHD in the
general public and treating CHD patients, according to authors.
“Anger and hostility were found to predict a 19 percent
and 24 percent increase in CHD events among initially healthy
people and those with pre-existing CHD, respectively,”
says Yoichi Chida, M.D., Ph.D., Department of Epidemiology
& Public Health, University College, London, UK. “The
harmful association of anger and hostility with CHD events
in healthy people was greater in men than women. This suggests
that the accumulation of stress responses in daily life might
have a greater impact on future CHD in men.”
Authors extensively reviewed the literature on the longitudinal
associations of anger and hostility with CHD events, and identified
25 studies of initially healthy populations and 18 studies
of patients with CHD. While the damaging effects of these
emotions have been widely asserted, previous reviews have
been inconclusive.
“This review provides further evidence that psychological
factors do matter in the development and progression of CHD,”
says Johan Denollet, Ph.D., CoRPS research center, Tilburg
University, The Netherlands, and co-author of the accompanying
editorial. “Clinicians should take symptoms of anger
and hostility seriously, and may consider referring their
patient for behavioral intervention. We need to closely monitor
and study these personality traits in order to do a better
job at identifying high-risk patients who are more liable
to future fatal and non-fatal coronary events.”
Interestingly, there was no longer a significant association
of anger and hostility with CHD when researchers performed
a subgroup analysis of the studies that controlled for behavioral
covariates (e.g., smoking, physical activity or body mass
index, socioeconomic status) and disease treatment, suggesting
that the major pathway between anger and hostility and CHD
might be behavioral risk factors. In addition, a direct physiological
pathway should be considered in future studies; this might
involve autonomic nervous dysregulation, increases in inflammatory
or coagulation factors such as C-reactive protein, interleukin
6 and fibrinogen, and higher cortisol levels.
Future research should also focus on the interplay between
negative emotions and emotion regulation strategies as a determinant
of major coronary events, according to Denollet.
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