Title: Anger and Coronary Heart Disease: Epidemiologic Evidence from the Atherosclerosis Risk in Communitie
1Anger and Coronary Heart Disease Epidemiologic
Evidence from the Atherosclerosis Risk in
Communities (ARIC) StudyJanice E. Williams,
PhD, MPHCenters for Disease Control and
Prevention
2The ARIC Study
- Two research arms
- Cohort
- Community morbidity/mortality surveillance
3Types of Anger
- Anger experience
- Transitory state (state anger)
- Stable and general predisposition to experience
anger (trait anger)
4Types of Anger
- Anger expression
- Anger in
- Anger out
- Anger control
5Trait Anger
- Subtypes
- Temperament
- Reaction
6Anger and CHD Studies
- Have employed the following study designs to
provide evidence of an association - cross-sectional
- prospective
- laboratory/clinical
7Anger and CHD ARIC Study
- Relationship of overall trait anger and subtypes
to - CHD (revascularization procedures, silent MI,
acute MI/fatal CHD)
8Methods
- 13,000 black and white men and women, aged 48 -
67, free of clinically manifest CHD - Completed Spielberger Trait Anger Scale
9Methods
- Followed from 1990 - 1995 for the occurrence of
CHD (revascularization procedures, silent MI,
acute MI/fatal CHD)
10Spielberger 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.
11Spielberger 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.
12Spielberger 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.
13Spielberger Trait Anger Scale (continued)
- I feel infuriated when I do a good job and get a
poor evaluation.
14Trait Anger-Temperament Subscale
- I am quick tempered.
- I have a fiery temper.
- I am a hotheaded person.
- I fly off the handle.
15Trait 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.
16Trait 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.
17Spielberger Trait Anger Scale
- Coding
- 1) Almost never
- 2) Sometimes
- 3) Often
- 4) Almost always
18Statistical Analyses
- Means and percentages to describe the population
by CHD risk factors. - -2 log likelihood tests to assess interactions of
covariates with anger.
19Statistical Analyses (continued)
- Proportional hazards regression models to assess
anger-CHD association. - Kaplan-Meier product limit method to assess
probabilities of CHD event-free survival.
20 Covariates
- Age
- Race
- Gender
- Education
- Waist-to-hip ratio
- LDL-and HDL-cholesterol
- Drinking
- Smoking
- Diabetes
21 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
22Multivariate-adjusted hazard ratios (95 C.I.)
for the association between overall trait anger
and CHD risk
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23Multivariate-adjusted hazard ratios (95 C.I.)
for the association between trait
anger-temperament and CHD risk
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24Multivariate-adjusted hazard ratios (95 C.I.)
for the association between trait anger-reaction
and CHD risk
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25Summary
- Overall trait anger was positively associated
with risk of both combined CHD and of hard
events (acute MI/fatal CHD) among normotensive
individuals.
26Summary
- Similarly, trait anger-temperament was positively
associated with combined CHD and with hard
events (acute MI/fatal CHD) among normotensive
individuals.
27Summary
- No statistically significant association was
observed between trait anger-reaction and CHD.
28Conclusions
- 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.
29The 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.
30The Mechanism
- Direct pathophysiological effects via heightened
sympathetic arousal and neuroendocrine activation.