Hostility and serum homocysteine as cardiovascular risk factors in Korean patients with coronary artery disease

Trait anger, hostility, serum homocysteine, and recurrent cardiac events after percutaneous coronary interventions

BACKGROUND

Trait anger, hostility, and serum level of homocysteine are associated with recurrent cardiac events after percutaneous coronary interventions. However, whether trait anger or hostility influences the association between serum level of homocysteine and recurrent cardiac events is unknown.

OBJECTIVES

To examine the relationships among trait anger, hostility, serum level of homocysteine, and recurrent cardiac events after percutaneous coronary interventions.

METHODS

This prospective study included 135 consecutive patients (68% male, mean age 61 [SD, 10] years) undergoing percutaneous coronary interventions during an index hospitalization. Trait anger and hostility were measured with the Spielberger Trait Anger Scale and the Cynical Hostility Scale, respectively. Blood samples were obtained to measure serum levels of total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, and homocysteine. Recurrent cardiac events (emergency department visits and rehospitalization) were noted for 6 months after discharge and confirmed by review of hospital records. Hierarchical Cox hazard regression was used for statistical analysis.

RESULTS

Trait anger (hazard ratio = 1.11, 95% confidence interval = 1.03-1.20) and homocysteine level (hazard ratio = 1.10, 95% confidence interval = 1.01-1.21) were independent predictors of recurrent cardiac events after other risk factors were controlled for. Patients with high trait anger (score > or = 24) and high serum level of homocysteine (> or = 11.3 mumol/L) had the shortest time to recurrent cardiac events (P = .01).

CONCLUSION

Trait anger had a combined effect on the link between serum level of homocysteine and recurrent cardiac events. Interventions to reduce trait anger may improve health outcomes by influencing both trait anger and homocysteine level.

Cynical hostility as a determinant of poor oral health status in an adult population

Our aim in this study was to determine whether there is an association between cynical hostility and clinically determined poor oral health, and whether this association is confounded by socioeconomic position and mediated by health behavior. The sample consisted of 4,207 dentate Finns, 30-64 yr of age. Oral health was measured in terms of numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets (> or = 4 mm). Cynical hostility was measured using the cynical distrust self-administered questionnaire. The subjects with the highest level of cynical hostility had fewer teeth, and a greater number of decayed teeth as well as teeth with deepened periodontal pockets compared to subjects with the lowest level of cynical hostility. The associations between cynical hostility and number of missing and decayed teeth were clearly confounded by level of education. Poor oral health behavior was shown to be a possible mediator between cynical hostility and number of decayed teeth, but not of missing teeth or teeth with deepened periodontal pockets. General health-related behavior did not serve as a possible mediator in any of the associations. In conclusion, cynical hostility can be considered as a risk marker for poor oral health. Interventions aimed to improve oral health should focus on psychosocial factors and on less-educated subjects.