Hostility, Anger, and Heart Disease

by Amy Scholten, MPH
BeliefNet

Man expressing anger "You will not be punished for your anger — you will be punished by your anger." – Buddha

"Anger does more harm than the condition which aroused anger." – David O. Mckay

"Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else — you are the one getting burned." – Buddha

"Indulge not thyself in the passion of anger; it is whetting a sword to wound thine own breast, or murder thy friend." – Akhen-aton

"When anger arises, think of the consequences." – Confucius

Sages through the ages have warned us about hostility and anger, and now research seems to confirm their admonitions. A number of studies suggest that high levels of hostility and anger are associated with coronary heart disease (CHD). In fact, a study published in the November 2002 issue of Health Psychology suggests that hostility may predict CHD more than other risk factors such as cholesterol and smoking.

Researchers Explore Hostility-Heart Disease Link in Men

Hostility is an attitudinal, emotional and behavioral construct that includes:

Negative beliefs about and attitudes toward others, including cynicism and mistrust
Anger, an unpleasant emotion ranging from irritation to rage
Actions or thoughts of harming others either verbally or physically

In an effort to determine whether hostility was an independent influence or contributing factor in the development of coronary heart disease, Raymond Niaura, PhD of Brown University, and his colleagues, looked at a sample of 774 predominately white men (average age 60) who participated in the Normative Aging Study (NAS).

The following factors were assessed over a three-year period, beginning in 1986:

Hostility levels, measured by the Cook-Medley Hostility Scale (Ho) of the Minnesota Multiphasic Personality Inventory (MMPI)
Blood lipids: total cholesterol, HDL and LDL cholesterol, and triglycerides
Fasting insulin
Blood pressure
Body mass index (BMI), a measurement of height and weight to determine obesity
Waist-to-hip ratio (WHR)
Health behaviors, including:
º Cigarette smoking
º Alcohol consumption
º Total dietary calories
Education level
Incidence of coronary heart disease (CHD)

Results: Hostility May Independently Predict CHD

During the three-year NAS study, 45 of the men had an initial episode of CHD (defined as a heart attack, angina, or abnormal electrocardiogram). New episodes of CHD were more common in men with higher levels of hostility than those with other risk factors for CHD. Other risk factors for CHD, including high blood pressure, total cholesterol levels, fasting insulin, measurements of obesity and body fat distribution (BMI and WHR), and even smoking, did not predict a man´s risk of CHD during those three years.

Of the physiological measures, only levels of HDL or "good" cholesterol predicted a man´s risk of heart disease for the three years of the study. Specifically, HDL had a protective effect against CHD. However, hostility levels predicted incidences of CHD independent of the effect of HDL.

This study is consistent with other studies demonstrating that hostility is associated with and predicts the incidence CHD above and beyond the traditionally assessed risk factors. According to the researchers, the findings also demonstrated that hostility predicted incident CHD above and beyond factors related to the metabolic syndrome. Specifically, older men with the highest levels of hostility were at greatest risk for incident CHD, independent of the effects of fasting insulin, BMI, WRH, triglyceride levels, and blood pressure.

The researchers speculate that hostility may influence certain health behaviors that increase risk of CHD. Hostility may also be associated with sociodemographic characteristics (such as education level, income, job status, race) that are, in turn, associated with increased risk of CHD. Finally, hostility may be associated with changes in the body that could hasten atherosclerosis.

Study Limitations

The researchers acknowledge that the study had a number of limitations, including:

It involved older, primarily white men of normal health status, and therefore limited the ability to generalize the results to younger adults, women, and other ethnic minority populations.
The ability to detect significant effects may have been low because of the relatively low incidence of CHD. A longer follow-up might have provided this opportunity.
It did not include measures of perceived stress, stress hormones, and other CHD risk factors.

The researchers recommend that future studies examining the relationship between hostility and CHD should focus on more diverse populations and other physiological, behavioral, and genetic factors.

Psychological Interventions for Hostility and Anger

According to Dr. Niaura, the study findings suggest that mental health professionals continue to look at the effectiveness of psychological interventions for people with high levels of hostility.

For help in managing anger, the American Psychological Association recommends finding books, courses, or therapists that can teach you:

Relaxation techniques
How to change thinking that leads to anger
Healthy communication strategies
Problem solving techniques
How to use humor
How to be assertive
Strategies for managing or eliminating stressors

Counseling should be considered if you feel that your anger is out of control, or if it is having a negative effect on your relationships or other important parts of your life.

RESOURCES:

American Psychological Association

Mental Health and Behavior
Familydoctor.org (American Academy of Family Physicians)

SOURCES:

American Psychological Association website. Controlling anger before it controls you.

Niaura, R., Todaro, J., Stroud, L. et al. Hostility, the metabolic syndrome, and incident coronary heart disease. Health Psychology. 2002;21:588-593.

University of California San Francisco. John D. and Catherine T. MacArthur Research Network on Socioeconomic Status and Health.


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	Hostility, Anger, and Heart Disease by Amy Scholten, MPH BeliefNet "You will not be punished for your anger — you will be punished by your anger." – Buddha "Anger does more harm than the condition which aroused anger." – David O. Mckay "Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else — you are the one getting burned." – Buddha "Indulge not thyself in the passion of anger; it is whetting a sword to wound thine own breast, or murder thy friend." – Akhen-aton "When anger arises, think of the consequences." – Confucius Sages through the ages have warned us about hostility and anger, and now research seems to confirm their admonitions. A number of studies suggest that high levels of hostility and anger are associated with coronary heart disease (CHD). In fact, a study published in the November 2002 issue of Health Psychology suggests that hostility may predict CHD more than other risk factors such as cholesterol and smoking. Researchers Explore Hostility-Heart Disease Link in Men Hostility is an attitudinal, emotional and behavioral construct that includes: Negative beliefs about and attitudes toward others, including cynicism and mistrust Anger, an unpleasant emotion ranging from irritation to rage Actions or thoughts of harming others either verbally or physically In an effort to determine whether hostility was an independent influence or contributing factor in the development of coronary heart disease, Raymond Niaura, PhD of Brown University, and his colleagues, looked at a sample of 774 predominately white men (average age 60) who participated in the Normative Aging Study (NAS). The following factors were assessed over a three-year period, beginning in 1986: Hostility levels, measured by the Cook-Medley Hostility Scale (Ho) of the Minnesota Multiphasic Personality Inventory (MMPI) Blood lipids: total cholesterol, HDL and LDL cholesterol, and triglycerides Fasting insulin Blood pressure Body mass index (BMI), a measurement of height and weight to determine obesity Waist-to-hip ratio (WHR) Health behaviors, including: º Cigarette smoking º Alcohol consumption º Total dietary calories Education level Incidence of coronary heart disease (CHD) Results: Hostility May Independently Predict CHD During the three-year NAS study, 45 of the men had an initial episode of CHD (defined as a heart attack, angina, or abnormal electrocardiogram). New episodes of CHD were more common in men with higher levels of hostility than those with other risk factors for CHD. Other risk factors for CHD, including high blood pressure, total cholesterol levels, fasting insulin, measurements of obesity and body fat distribution (BMI and WHR), and even smoking, did not predict a man´s risk of CHD during those three years. Of the physiological measures, only levels of HDL or "good" cholesterol predicted a man´s risk of heart disease for the three years of the study. Specifically, HDL had a protective effect against CHD. However, hostility levels predicted incidences of CHD independent of the effect of HDL. This study is consistent with other studies demonstrating that hostility is associated with and predicts the incidence CHD above and beyond the traditionally assessed risk factors. According to the researchers, the findings also demonstrated that hostility predicted incident CHD above and beyond factors related to the metabolic syndrome. Specifically, older men with the highest levels of hostility were at greatest risk for incident CHD, independent of the effects of fasting insulin, BMI, WRH, triglyceride levels, and blood pressure. The researchers speculate that hostility may influence certain health behaviors that increase risk of CHD. Hostility may also be associated with sociodemographic characteristics (such as education level, income, job status, race) that are, in turn, associated with increased risk of CHD. Finally, hostility may be associated with changes in the body that could hasten atherosclerosis. Study Limitations The researchers acknowledge that the study had a number of limitations, including: It involved older, primarily white men of normal health status, and therefore limited the ability to generalize the results to younger adults, women, and other ethnic minority populations. The ability to detect significant effects may have been low because of the relatively low incidence of CHD. A longer follow-up might have provided this opportunity. It did not include measures of perceived stress, stress hormones, and other CHD risk factors. The researchers recommend that future studies examining the relationship between hostility and CHD should focus on more diverse populations and other physiological, behavioral, and genetic factors. Psychological Interventions for Hostility and Anger According to Dr. Niaura, the study findings suggest that mental health professionals continue to look at the effectiveness of psychological interventions for people with high levels of hostility. For help in managing anger, the American Psychological Association recommends finding books, courses, or therapists that can teach you: Relaxation techniques How to change thinking that leads to anger Healthy communication strategies Problem solving techniques How to use humor How to be assertive Strategies for managing or eliminating stressors Counseling should be considered if you feel that your anger is out of control, or if it is having a negative effect on your relationships or other important parts of your life. RESOURCES: American Psychological Association Mental Health and Behavior Familydoctor.org (American Academy of Family Physicians) SOURCES: American Psychological Association website. Controlling anger before it controls you. Niaura, R., Todaro, J., Stroud, L. et al. Hostility, the metabolic syndrome, and incident coronary heart disease. Health Psychology. 2002;21:588-593. University of California San Francisco. John D. and Catherine T. MacArthur Research Network on Socioeconomic Status and Health.