Anger expression and prognosis after a coronary event in women

Abstract

Background: Suggestive evidence supports that anger is associated with increased cardiovascular morbidity and mortality. However, the knowledge regarding the impact of anger on prognosis after a coronary event, especially among women is limited. We investigated whether anger expression increases the risk of recurrent events in women with coronary heart disease (CHD).

Methods: Women (n=203) hospitalized for an acute cardiac event were assessed for the four scales of the Framingham Anger Questionnaire, demographic, biomedical and lifestyle factors and were followed for 6.4+/-1 years for total mortality and the combination of cardiovascular death and non-fatal acute myocardial infarction (AMI).

Results: After adjustment for confounders such as age, inclusion diagnosis and smoking in the proportional hazard models the tendency to suppress angry feelings was associated with the combination of cardiac death and recurrent AMI (hazard ratio (HR): 1.19, 95% confidence interval (CI): 0.99-1.42) and with all-cause mortality (HR:1.29, 95% CI: 1.03-1.60). Each unit increase in the outward expression of anger increased by 42% the risk for cardiac death or a new AMI (95% CI: 1.01-2.00). Among the potential biological mediators only inflammatory markers attenuated somewhat the relationship. Anger symptoms and discussion of anger were not related to prognosis.

Conclusions: The outward expression and the suppression of anger seem to be associated with prognosis in women with CHD. Future studies need to confirm these findings and to test whether behavioural intervention programs aiming to reduce detrimental anger behaviour in women can influence CHD prognosis.