Anger and Coronary Heart Disease: Epidemiologic Evidence from the Atherosclerosis Risk in...
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Transcript of Anger and Coronary Heart Disease: Epidemiologic Evidence from the Atherosclerosis Risk in...
Anger and Coronary Heart Disease:
Epidemiologic Evidence from the Atherosclerosis Risk in
Communities (ARIC) Study
Janice E. Williams, PhD, MPHCenters for Disease Control and
Prevention
The ARIC Study
• Two research arms
–Cohort
–Community morbidity/mortality surveillance
Types of Anger
• Anger experience
–Transitory state (state anger)
–Stable and general predisposition to experience anger (trait anger)
Types of Anger
• Anger expression
–Anger in
–Anger out
–Anger control
Trait Anger
• Subtypes–Temperament
–Reaction
Anger and CHD Studies
• Have employed the following study designs to provide evidence of an association– cross-sectional– prospective– laboratory/clinical
Anger and CHD: ARIC Study
• Relationship of overall trait anger and subtypes to
–CHD (revascularization procedures, silent MI, acute MI/fatal CHD)
Methods
• 13,000 black and white men and women, aged 48 - 67, free of clinically manifest CHD
• Completed Spielberger Trait Anger Scale
Methods
• Followed from 1990 - 1995 for the occurrence of CHD (revascularization procedures, silent MI, acute MI/fatal CHD)
Spielberger Trait Anger Scale
• I am quick tempered.
• I have a fiery temper.
• I am a hotheaded person.
• I get angry when I am slowed down by others’ mistakes.
Spielberger Trait Anger Scale (continued)
• I feel annoyed when I am not given recognition for doing good work.
• I fly off the handle.• When I get angry, I say nasty
things.
Spielberger Trait Anger Scale (continued)
• It makes me furious when I am criticized in front of others.
• When I get frustrated, I feel like hitting someone.
Spielberger Trait Anger Scale (continued)
• I feel infuriated when I do a good job and get a poor evaluation.
Trait Anger-Temperament Subscale
• I am quick tempered.
• I have a fiery temper.
• I am a hotheaded person.
• I fly off the handle.
Trait Anger - Reaction Subscale
• I get angry when I am slowed down by others’ mistakes.
• I feel annoyed when I am not given recognition for doing good work.
Trait Anger - Reaction Subscale (continued)
• It makes me furious when I am criticized in front of others.
• I feel infuriated when I do a good job and get a poor evaluation.
Spielberger Trait Anger Scale
• Coding
–1) Almost never
–2) Sometimes
–3) Often
–4) Almost always
Statistical Analyses
• Means and percentages to describe the population by CHD risk factors.
• -2 log likelihood tests to assess interactions of covariates with anger.
Statistical Analyses (continued)
• Proportional hazards regression models to assess anger-CHD association.
• Kaplan-Meier product limit method to assess probabilities of CHD event-free survival.
Covariates
•Age •Race •Gender •Education •Waist-to-hip ratio •LDL-and HDL-cholesterol
•Drinking •Smoking •Diabetes
Results
• Compared to their low-anger counterparts, persons high in trait anger were more likely to:– be smokers and drinkers– be heavier – have less formal education
Multivariate-adjusted hazard ratios (95% C.I.) for the association between
overall trait anger and CHD risk
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1
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5
Normo Hyper Normo Hyper
Multivariate-adjusted hazard ratios (95% C.I.) for the association between
trait anger-temperament and CHD risk
0
1
2
3
4
5
Normo Hyper Normo Hyper
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Multivariate-adjusted hazard ratios (95% C.I.) for the association between
trait anger-reaction and CHD risk
0
1
2
3
4
5
Full Cohort Full Cohort
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_
_
Summary
• Overall trait anger was positively associated with risk of both combined CHD and of “hard” events (acute MI/fatal CHD) among normotensive individuals.
Summary
• Similarly, trait anger-temperament was positively associated with combined CHD and with “hard” events (acute MI/fatal CHD) among normotensive individuals.
Summary
• No statistically significant association was observed between trait anger-reaction and CHD.
Conclusions
• A fiery temper predisposes middle-aged normotensive persons to a greater risk of CHD than anger aroused in reaction to frustration, criticism, or unfair treatment.
The Mechanism
• High-anger persons, compared to their low-anger counterparts, may be more likely to engage in unhealthy behaviors that place them at risk for CHD.
The Mechanism
• Direct pathophysiological effects via heightened sympathetic arousal and neuroendocrine activation.