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(Circulation. 1996;94:2090.)
© 1996 American Heart Association, Inc.
A Prospective Study of Anger and Coronary Heart Disease
The Normative Aging Study
the Department of Health and Social Behavior, Harvard School of Public Health, and Channing Laboratory, Harvard Medical School (I.K.); the Normative Aging Study, Department of Veterans Affairs Outpatient Clinic (P.V.), and Channing Laboratory, Harvard Medical School (D.S., A.S.); and Channing Laboratory, Brigham and Women's Hospital, and Pulmonary and Critical Care Division, Beth Israel Hospital, and Harvard Medical School (S.T.W.), Boston, Mass.
Correspondence to Dr I. Kawachi, Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115.
Background Recent laboratory and epidemiological studies have suggested that high levels of anger may increase the risk of coronary heart disease (CHD).
Methods and Results We examined prospectively the relationship of anger to CHD incidence in the Veterans Administration Normative Aging Study, an ongoing cohort of older (mean age, 61 years) community-dwelling men. A total of 1305 men who were free of diagnosed CHD completed the revised Minnesota Multiphasic Personality Inventory (MMPI-2) in 1986. Subjects were categorized according to their responses to the MMPI-2 Anger Content Scale, which measures the degree to which individuals have problems controlling their anger. During an average of 7 years of follow-up, 110 cases of incident CHD occurred, including 30 cases of nonfatal myocardial infarction (MI), 20 cases of fatal CHD, and 60 cases of angina pectoris. Compared with men reporting the lowest levels of anger, the multivariate-adjusted relative risks among men reporting the highest levels of anger were 3.15 (95% confidence interval [CI]: 0.94 to 10.5) for total CHD (nonfatal MI plus fatal CHD) and 2.66 (95% CI: 1.26 to 5.61) for combined incident coronary events including angina pectoris. A dose-response relation was found between level of anger and overall CHD risk (P for trend, .008).
Conclusions These data suggest that high levels of expressed anger may be a risk factor for CHD among older men.
Key Words: coronary disease • stress • anger • hostility
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