Hostility / Anger and Coronary Heart Disease

Based on the results from these early studies, the construct of hostility has been redefined to include behavioral, affective, and cognitive components. Expressive hostility refers to the expression of overt behaviors, such as anger expression, aggressive or rude behaviors, or assaultive behaviors. Potential for hostility refers to the tendency to experience anger and resentment in daily life. Hostility is frequently measured by self-rating scales such as the Cook and Medley Hostility Inventory or by a structured interview refined from the type A structured interview.

Several lines of inquiry have been used to investigate the association of hostility and anger with the development of CHD, including laboratory studies and population studies. Laboratory studies have focused on evaluating the physiologic and cardiovascular effects in hostile personality types. People with hostile personalities usually have greater blood pressure, heart rate, and neuroendocrine responses, such as cortisol release, when challenged with a frustrating or harassing situation. It has been hypothesized that the increased “reactivity” over the course of life events promotes the atherosclerotic process.

To elucidate the relationship between hostility and CHD development, researchers have examined this construct among children and adolescents. In young adults, high hostility levels have been related to unhealthy lifestyle habits later in life. For example, the Coronary Artery Risk Development in Young Adults (CARDIA) study found a positive relationship between hostility and lifestyle behaviors such as cigarette smoking, body weight, and alcohol consumption. Similarly, studies in adults also support that the association between CHD mortality and morbidity might be mediated by behavioral risk factors. The Finnish Kuopio Study found that men with high hostility scores followed for 9 years had more than a twofold risk for MI, although accounting for the behavioral risk factors of smoking, alcohol intake, and body mass index substantially reduced the risk. In contrast, prospective studies reported that high levels of anger and hostility were associated with as much as a twofold increase in risk of a coronary event compared with low levels. High levels of hostility were also predictive of restenosis after angioplasty. Perhaps the most compelling evidence associating anger and hostility with the development of CHD is from a study of Finnish men who were followed with serial carotid ultrasound. In this study, a twofold increase in carotid artery disease over a 2-year period was observed in men reporting high levels of cynical distrust and anger control.

In summary, studies continue to observe an inconsistent relationship between the development of CHD and type A behavior or specific constructs such as hostility and anger. However, the link between the personality traits of anger and hostility with cardiac reactivity suggests an important physiologic pathway for triggering cardiovascular events.

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