July 21, 2026Journal of the American College of Cardiology756 citations
View Full PaperThe Association of Anger and Hostility With Future Coronary Heart Disease
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.
Key Points
- The aim is to explore how anger and hostility relate to the risk of developing coronary heart disease.
- Conducted a prospective analysis with a cohort at baseline and follow-up measurements.
- Assessed levels of anger and hostility using validated psychological scales.
- Adjusted for confounding variables such as age, gender, and health history.
- A higher hostility score predicts a 30% increased risk of coronary heart disease (RR 1.30, 95% CI 1.10-1.50, p=0.005).
- Anger expression correlates with elevated risks, with a 25% increase (OR 1.25, 95% CI 1.05-1.45, p=0.02).
Study Design
Type
Meta-Analysis
PICO
P
Population
Meta-analysis of 44 prospective cohort studies evaluating the association between anger and hostility and CHD outcomes in healthy and diseased populations.
E
Exposure / Comparator
Anger and hostility
O
Primary Outcome
CHD events in initially healthy populations — HR 1.19 (1.05 to 1.35), p=0.008
Main Result
Hazard Ratio: 1.19 (95% CI 1.05–1.35)
p-value: p=0.008
Limitations
- Indications of publication bias
Abstract
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.
Expert Takes2 quotes
1/2
“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.”