Components of the Anger-Hostility Complex and Symptom Reporting in Patients with Coronary Artery Disease: A Multi-Measure Study

Multiple anger and hostility variables were investigated for associations with coronary artery disease (CAD) symptoms and to examine if those relationships were different for disease severity.Atwo year follow-up study of97 men with stenosed coronary arteries was undertaken. Questionnaires measured: nine forms of anger and hostility; Type A behaviour; anxiety; depression; social support; and ninesymptom measures. CAD severity was derived from clinicians’ ratings of coronary angiograms. Results are four fold: anger-hostility variables are relatively unimportant predictors of symptoms compared with anxiety and depression; psychosocial measures (except for expressed anger) are uncorrelated with CAD severity, though correlate numerously with CAD symptoms; symptoms are not distinguishable empirically in terms of frequency, intensity and duration with regard to type (‘angina pain’, ‘tiredness’ and ‘breathlessness and restricted mobility’); finally, CADsymptoms are unrelated to CAD severity. In conclusion, components of the angerhostility complex are of limited use for predicting CAD symptoms. However, anger expression is of utility for differentiating between CAD symptoms and disease severity.

Mood symptoms and personality dimensions as determinants of health-related quality of life in patients with coronary artery disease

This study examined the effects of personality dimensions in relation to the symptoms of depression and anxiety on health-related quality of life in coronary artery disease patients (N = 514). A linear regression analysis showed that symptoms of depression and anxiety as well as personality trait of emotional stability have independent significant effect on the health-related quality of life in patients with coronary artery disease. Psychological interventions in coronary artery disease patients should not only be limited to the treatment of symptoms of depression and anxiety but should also be extended to the management of personality traits.

Anger expression and prognosis after a coronary event in women

BACKGROUND

Suggestive evidence supports that anger is associated with increased cardiovascular morbidity and mortality. However, the knowledge regarding the impact of anger on prognosis after a coronary event, especially among women is limited. We investigated whether anger expression increases the risk of recurrent events in women with coronary heart disease (CHD).

METHODS

Women (n=203) hospitalized for an acute cardiac event were assessed for the four scales of the Framingham Anger Questionnaire, demographic, biomedical and lifestyle factors and were followed for 6.4+/-1 years for total mortality and the combination of cardiovascular death and non-fatal acute myocardial infarction (AMI).

RESULTS

After adjustment for confounders such as age, inclusion diagnosis and smoking in the proportional hazard models the tendency to suppress angry feelings was associated with the combination of cardiac death and recurrent AMI (hazard ratio (HR): 1.19, 95% confidence interval (CI): 0.99-1.42) and with all-cause mortality (HR:1.29, 95% CI: 1.03-1.60). Each unit increase in the outward expression of anger increased by 42% the risk for cardiac death or a new AMI (95% CI: 1.01-2.00). Among the potential biological mediators only inflammatory markers attenuated somewhat the relationship. Anger symptoms and discussion of anger were not related to prognosis.

CONCLUSIONS

The outward expression and the suppression of anger seem to be associated with prognosis in women with CHD. Future studies need to confirm these findings and to test whether behavioural intervention programs aiming to reduce detrimental anger behaviour in women can influence CHD prognosis.

Asymmetry in hand grip strength and fatigue in low- and high-hostile men

The present study examined the relationship between hostility level and cerebral hemispheric motor functioning of 70 left-cerebral dominant men. Using the Cook-Medley Hostility Scale, the subject group was divided into thirds: One-third (N = 23) were classified as low-hostile, one-third (N = 23) were classified as high-hostile, and the remainder (N = 24) were excluded from analysis. A hand dynamometer was used to assess hand grip strength, perseveration, and fatigue, as measures of hemispheric motor functioning. Results yielded a hand-by-hostility group interaction, which indicated that high-hostile men evidenced significantly less hand grip strength at the right hand and significantly greater hand grip strength at the left hand relative to low-hostile men. These results suggest that high-hostile men may experience relatively greater right-cerebral arousal relative to their low-hostile counterparts. In other results, both groups showed greater perseveration at the left hand than at the right hand. Both groups also showed significant fatigue across trials at both hands. Analysis also revealed a hand-by-trial interaction, indicating that the right hand fatigued more quickly than the left hand across trials. Resistance to fatigue at the left hand and overestimation or relative imprecision in motor movement at the left hand are discussed in terms of arousal theory. These results and others are cited as contributing inroads into distinguishing between the emotional problems of depression, anxiety, and hostility.