on March 1, 2004
Published online before print March 1, 2004, doi: 10.1161/01.CIR.0000118535.15205.8F
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Submitted on July 1, 2003
From Eaker Epidemiology Enterprises, LLC, Chili, Wis (E.D.E.); the Department of Mathematics and Statistics, Boston University School of Public Health, Boston, Mass (L.M.S., R.B.D.); the Departments of Neurology and Cardiology, Boston University School of Medicine, Boston, Mass (M.K.-H.); and the National Heart, Lung, and Blood Institutes’ Framingham Heart Study (L.M.S., M.K.-H., R.B.D., E.J.B.), Bethesda, Md. * To whom correspondence should be addressed. E-mail: eakerepi{at}tznet.com.
Background--Conflicting findings in the literature with regard to the ability of type A behavior, expressions of anger, or hostility to predict incident coronary heart disease (CHD) have created controversy. In addition, there are no prospective studies relating these characteristics to the development of atrial fibrillation (AF). Methods and Results--From 1984 to 1987, 3873 men and women, 18 to 77 years of age, participating in the Framingham Offspring Study, were examined and monitored for 10 years for the incidence of CHD, AF, and total mortality. Measures of type A behavior, anger, hostility, and risk factors for CHD and AF were collected at the baseline examination. After controlling for age, diabetes, hypertension, history of myocardial infarction, history of congestive heart failure, and valvular heart disease in Cox proportional hazards models, trait-anger (RR=1.1; 95% CI, 1.0 to 1.4; P=0.04), symptoms of anger (RR=1.2; 95% CI, 1.0 to 1.4; P=0.008), and hostility (RR=1.3; 95% CI, 1.1 to 1.5; P=0.003) were predictive of 10-year incidence of AF in men. After controlling for risk factors for CHD, none of the measures of anger, type A behavior, or hostility were related to incident CHD; however, trait-anger (RR=1.2; 95% CI, 1.1 to 1.4; P<0.01) was related to total mortality in men. None of the psychosocial variables were related to the 3 outcomes in women. Conclusions--This is the first study to examine and demonstrate a predictive relation between measures of anger and hostility to the development of AF in men. As opposed to type A behavior, measures of anger and hostility may be more productive avenues for research in studying the risk of arrhythmias and total mortality in men.
Revised on November 21, 2003
Accepted on November 26, 2003
Anger and Hostility Predict the Development of Atrial Fibrillation in Men in the Framingham Offspring Study
Elaine D. Eaker ScD*,
Key words: coronary disease • fibrillation • mortality • men • arrhythmia
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