Anger%20and%20Coronary%20Heart%20Disease:%20%20Epidemiologic%20Evidence%20from%20the%20Atherosclerosis%20Risk%20in%20Communities%20(ARIC)%20Study%20Janice%20E.%20Williams,%20PhD,%20MPH%20Centers%20for%20Disease%20Control%20and%20Prevention

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Anger and Coronary Heart Disease Epidemiologic
Evidence from the Atherosclerosis Risk in
Communities (ARIC) StudyJanice E. Williams,
PhD, MPHCenters for Disease Control and
Prevention
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The ARIC Study

• Two research arms
• Cohort
• Community morbidity/mortality surveillance

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Types of Anger

• Anger experience
• Transitory state (state anger)
• Stable and general predisposition to experience
  anger (trait anger)

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Types of Anger

• Anger expression
• Anger in
• Anger out
• Anger control

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Trait Anger

• Subtypes
• Temperament
• Reaction

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Anger and CHD Studies

• Have employed the following study designs to
  provide evidence of an association
• cross-sectional
• prospective
• laboratory/clinical

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Anger and CHD ARIC Study

• Relationship of overall trait anger and subtypes
  to
• CHD (revascularization procedures, silent MI,
  acute MI/fatal CHD)

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Methods

• 13,000 black and white men and women, aged 48 -
  67, free of clinically manifest CHD
• Completed Spielberger Trait Anger Scale

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Methods

• Followed from 1990 - 1995 for the occurrence of
  CHD (revascularization procedures, silent MI,
  acute MI/fatal CHD)

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Spielberger Trait Anger Scale

• I am quick tempered.
• I have a fiery temper.
• I am a hotheaded person.
• I get angry when I am slowed down by others
  mistakes.

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Spielberger Trait Anger Scale (continued)

• I feel annoyed when I am not given recognition
  for doing good work.
• I fly off the handle.
• When I get angry, I say nasty things.

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Spielberger Trait Anger Scale (continued)

• It makes me furious when I am criticized in front
  of others.
• When I get frustrated, I feel like hitting
  someone.

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Spielberger Trait Anger Scale (continued)

• I feel infuriated when I do a good job and get a
  poor evaluation.

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Trait Anger-Temperament Subscale

• I am quick tempered.
• I have a fiery temper.
• I am a hotheaded person.
• I fly off the handle.

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Trait Anger - Reaction Subscale

• I get angry when I am slowed down by others
  mistakes.
• I feel annoyed when I am not given recognition
  for doing good work.

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Trait Anger - Reaction Subscale (continued)

• It makes me furious when I am criticized in front
  of others.
• I feel infuriated when I do a good job and get a
  poor evaluation.

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Spielberger Trait Anger Scale

• Coding
• 1) Almost never
• 2) Sometimes
• 3) Often
• 4) Almost always

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Statistical Analyses

• Means and percentages to describe the population
  by CHD risk factors.
• -2 log likelihood tests to assess interactions of
  covariates with anger.

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Statistical Analyses (continued)

• Proportional hazards regression models to assess
  anger-CHD association.
• Kaplan-Meier product limit method to assess
  probabilities of CHD event-free survival.

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Covariates

• Age
• Race
• Gender
• Education
• Waist-to-hip ratio
• LDL-and HDL-cholesterol

• Drinking
• Smoking
• Diabetes

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Results

• Compared to their low-anger counterparts, persons
  high in trait anger were more likely to
• be smokers and drinkers
• be heavier
• have less formal education

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Multivariate-adjusted hazard ratios (95 C.I.)
for the association between overall trait anger
and CHD risk
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Multivariate-adjusted hazard ratios (95 C.I.)
for the association between trait
anger-temperament and CHD risk
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Multivariate-adjusted hazard ratios (95 C.I.)
for the association between trait anger-reaction
and CHD risk
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Summary

• Overall trait anger was positively associated
  with risk of both combined CHD and of hard
  events (acute MI/fatal CHD) among normotensive
  individuals.

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Summary

• Similarly, trait anger-temperament was positively
  associated with combined CHD and with hard
  events (acute MI/fatal CHD) among normotensive
  individuals.

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Summary

• No statistically significant association was
  observed between trait anger-reaction and CHD.

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Conclusions

• A fiery temper predisposes middle-aged
  normotensive persons to a greater risk of CHD
  than anger aroused in reaction to frustration,
  criticism, or unfair treatment.

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The Mechanism

• High-anger persons, compared to their low-anger
  counterparts, may be more likely to engage in
  unhealthy behaviors that place them at risk for
  CHD.

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The Mechanism

• Direct pathophysiological effects via heightened
  sympathetic arousal and neuroendocrine activation.