Observed Hostility and the Risk of Incident Ischemic Heart Disease: A Prospective Population Study From the 1995 Canadian Nova Scotia Health Survey

Study Questions:

What is the relation between hostility and the various expressions of hostility and incident ischemic heart disease (IHD), and is observed hostility superior to patient-reported hostility for the prediction of IHD?


The authors explored the independent relationship between baseline observed hostility and 10-year incident IHD in 1,749 adults of the population-based Canadian Nova Scotia Health Survey. The target sample was to be representative of the Nova Scotian population by age, sex, and geographic location. Study participants consisted of noninstitutionalized Nova Scotians listed in the government-sponsored universal health insurance plan. A 12-minute stressful interview, Expanded Structured Interview (ESI), was used to assess a number of psychosocial characteristics, including hostility, anger expression, and positive affect, through responses to a variety of different situations. Participants express hostility, through hostile statements, vocal hostility, or a combination of both. Depression and patient-reported hostility were assessed with standard validated multiple choice tools.


There were 149 (8.5%) incident IHD events (140 nonfatal, 9 fatal) during the 15,295 person-years of observation (9.74 events/1,000 person-years). Participants with any observed hostility had a greater risk of incident IHD than those without (p = 0.02); no such relation was found for patient-reported hostility. Those with any observed hostility had a significantly greater risk of incident IHD (hazard ratio, 2.06; 95% confidence interval, 1.04-4.08; p = 0.04), after adjusting for cardiovascular (age, sex, Framingham risk score) and psychosocial (depression, positive affect, patient-reported hostility, and anger) risk factors.


The presence of any observed hostility at baseline was associated with a twofold increased risk of incident IHD over 10 years of follow-up. Compared with patient-reported measures, observed hostility is a superior predictor of IHD.


Hostility was identified to be a major component of the ‘coronary prone behavior’ or Type A personality over 20 years ago. This study adds to the large body of literature confirming hostility as a risk factor or risk marker for IHD, but adds the dimension that relationship is not linear and any detectable hostility is associated with IHD risk.

Keywords: Nova Scotia, Cardiovascular Diseases, Hostility, Type A Personality

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