Key result
Anger and hostility were significantly associated with increased CHD events in initially healthy populations (HR 1.19; 95% CI 1.05-1.35; p=0.008) and poor prognosis in those with existing CHD.
Why the study?
A harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews were inconclusive.
Meta-Analysis
Hazard Ratio: 1.19 (95% CI 1.05–1.35)
p-value: p=0.008
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This review provides further evidence that psychological factors do matter in the development and progression of CHD. Clinicians should take symptoms of anger and hostility seriously, and may consider referring their patient for behavioral intervention. We need to closely monitor and study these personality traits in order to do a better job at identifying high-risk patients who are more liable to future fatal and non-fatal coronary events.”
“Anger and hostility were found to predict a 19 percent and 24 percent increase in CHD events among initially healthy people and those with pre-existing CHD, respectively. The harmful association of anger and hostility with CHD events in healthy people was greater in men than women. This suggests that the accumulation of stress responses in daily life might have a greater impact on future CHD in men.”
Associated hostility elevates CHD risk; leaves open whether interventions targeting anger improve outcomes.
OBJECTIVES: This review aimed to evaluate the association between anger and hostility and coronary heart disease (CHD) in prospective cohort studies using quantitative methods. BACKGROUND: The harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews have been inconclusive. METHODS: We searched general bibliographic databases: MEDLINE, PsycINFO, Web of Science, and PubMed up to November 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. RESULTS: There were 25 studies (21 articles) investigating CHD outcomes in initially healthy populations and 19 studies (18 articles) of samples with existing CHD. Anger and hostility were associated with increased CHD events in the healthy population studies (combined hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.05 to 1.35, p = 0.008) and with poor prognosis in the CHD population studies (HR: 1.24; 95% CI: 1.08 to 1.42, p = 0.002). There were indications of publication bias in these reports, although the fail-safe numbers were 2,020 and 750 for healthy and disease population studies, respectively. Intriguingly, the harmful effect of anger and hostility on CHD events in the healthy populations was greater in men than women. In studies of participants with CHD at baseline that controlled fully for basal disease status and treatment, the association of anger and hostility with poor prognosis persisted. CONCLUSIONS: The current review suggests that anger and hostility are associated with CHD outcomes both in healthy and CHD populations. Besides conventional physical and pharmacological interventions, this supports the use of psychological management focusing on anger and hostility in the prevention and treatment of CHD.
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Chida et al. (2009) conducted a meta-analysis in Coronary heart disease. Anger and hostility was evaluated on CHD events in initially healthy populations (HR 1.19, 95% CI 1.05 to 1.35, p=0.008). Anger and hostility were significantly associated with increased CHD events in initially healthy populations (HR 1.19; 95% CI 1.05-1.35; p=0.008) and poor prognosis in those with existing CHD.
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