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Abstract
Increased research attention is being paid to the negative impact of anger on coronary
heart disease (CHD).
This study examined prospectively the association between trait anger and the risk
of combined CHD (acute myocardial infarction [MI]/fatal CHD, silent MI, or cardiac
revascularization procedures) and of "hard" events (acute MI/fatal CHD). Participants
were 12 986 black and white men and women enrolled in the Atherosclerosis Risk In
Communities study. In the entire cohort, individuals with high trait anger, compared
with their low anger counterparts, were at increased risk of CHD in both event categories.
The multivariate-adjusted hazard ratio (HR) (95% CI) was 1.54 (95% CI 1.10 to 2.16)
for combined CHD and 1.75 (95% CI 1.17 to 2.64) for "hard" events. Heterogeneity of
effect was observed by hypertensive status. Among normotensive individuals, the risk
of combined CHD and of "hard" events increased monotonically with increasing levels
of trait anger. The multivariate-adjusted HR of CHD for high versus low anger was
2.20 (95% CI 1.36 to 3.55) and for moderate versus low anger was 1.32 (95% CI 0.94
to 1.84). For "hard" events, the multivariate-adjusted HRs were 2.69 (95% CI 1.48
to 4.90) and 1.35 (95% CI 0.87 to 2.10), respectively. No statistically significant
association between trait anger and incident CHD risk was observed among hypertensive
individuals.
Proneness to anger places normotensive middle-aged men and women at significant risk
for CHD morbidity and death independent of the established biological risk factors.
The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study is designed to estimate patterns and trends of coronary heart disease (CHD) incidence, case fatality, and mortality in four U.S. communities. Community surveillance involves ongoing review of death certificates and hospital discharge records to identify CHD events in community residents aged 35-74 years. Interviews with next of kin and questionnaires completed by physicians and medical examiners or coroners were used to collect information on deaths, and review and abstraction of hospital records were used to collect information on possible fatal and nonfatal myocardial infarctions (MIs). Events were classified using standardized criteria. The initial 2-years' experience with case ascertainment and availability of information needed for classification of events is described. Average annual age-adjusted attack rates of definite MI and CHD mortality rates for blacks in two communities and whites in the four communities are presented and compared with rates based on unvalidated hospital discharge data and vital statistics. Age-adjusted rates based on ARIC classification of definite MI were lower than those based on hospital discharge diagnosis code 410 (e.g., 5.60/1000 and 11.50/1000 among Forsyth County white men, respectively). Age-adjusted rates of definite fatal CHD based on ARIC classification were similarly lower than rates based on underlying cause of death code 410; for example, Jackson black men had rates of 2.82/1000 and 4.52/1000 for definite fatal CHD and UCOD 410-414 or 429.2, respectively.
[1
]From the University of North Carolina (J.E.W., C.C.P., M.L.E., H.A.T.), Chapel Hill,
NC; Duke University Medical Center (I.C.S.), Durham, NC; and Johns Hopkins University,
Baltimore, Md (F.J.N.).