Journal of Behavioral Medicine

, Volume 15, Issue 3, pp 273–284

Anger and impatience/irritability in patients of low socioeconomic status with acute coronary heart disease

  • Carlos F. Mendes de Leon


This case-control study examines the relationship between anger and impatience/irritability and acute coronary heart disease (CHD) in middle-aged men of low socioeconomic status (SES). Subjects included patients with myocardial infarction (MI) (N=31) or unstable angina (AP) (N=26), who were compared with hospital controls (N=26). In separate multi-variate analyses for each anger scale, MI was associated with Anger-Out and Impatience/Irritability, particularly in the subgroup of patients who did not have a previous MI. The same factors were associated with AP, but only when this acute ischemic event was not preceded by a ML No relationship was found between Trait-Anger and Anger-In and either acute ischemic outcome. The results indicate that particularly overt behavioral expression of anger is related to CHD in lower SES patients and that there is similarity in the behavioral factors associated with acute CHD between low- and high-SES men.

Key words

anger impatience coronary heart disease socioeconomic status 


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  1. Costa, P. T., McCrae, R. R., and Dembroski, T. M. (1989). Agreeableness versus antagonism: Explication of a potential risk factor for CHD. In Siegman, A. W., and Dembroski, T. M. (eds.),In Search of Coronary Prone Behavior: Beyond Type A, Lawrence Erlbaum, Hillsdale, NJ, pp. 41–63.Google Scholar
  2. Dembroski, T. M., and Costa, P. T. (1987). Coronary prone behavior: components of the type A pattern and hostility.J. Personal. 55: 211–235.Google Scholar
  3. Dembroski, T. M., MacDougall, J. M., Williams, R. B., Haney, T. L., and Blumenthal, J. A. (1985). Components of Type A, hostility, and anger-in: Relationship to angiographic findings.Psychosom. Med. 47: 219–233.PubMedGoogle Scholar
  4. Dembroski, T. M., MacDougall, J. M., Costa, P. T., and Grandits, G. A. (1989). Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial.Psychosom. Med. 51: 514–522.PubMedGoogle Scholar
  5. Diamond, E. L. (1982). The role of anger and hostility in essential hypertension and coronary heart disease.Psychol. Bull. 92: 410–433.PubMedGoogle Scholar
  6. Dixon, W. J. (1988).BMDP Statistical Software Manual, University of California Press, Los Angeles.Google Scholar
  7. Haynes, S. G., Feinleib, M., and Kannel, W. B. (1980). The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease.Am. J. Epidemiol. 111: 37–58.PubMedGoogle Scholar
  8. Jenkins, C. D., and Zyzanski, S. J. (1980). Behavioral risk factors and coronary heart disease.Psychother. Psychosom. 34: 149–177.PubMedGoogle Scholar
  9. Jenkins, C. D., Zyzanski, S. J., and Rosenman, R. H. (1978). Coronary prone behavior. One pattern or several?Psychosom. Med. 40: 25–43.PubMedGoogle Scholar
  10. Koskenvuo, M., Kaprio, J., Rose, R. J., Kesäniemi, A., Sarna, S., Haikkilä, K., and Langin-vainio, H. (1988). Hostility as a risk factor for mortality and ischaemia heart disease in men.Psychosom. Med. 50: 330–340.PubMedGoogle Scholar
  11. MacDougall, J. M., Dembroski, T. M., Dimsdale, J. E., and Hackett, T. P. (1985). Components of Type A, hostility, and anger-in: Further relationships to angiographic findings.Health Psychol. 4: 137–152.PubMedGoogle Scholar
  12. Matthews, K. A., Feinleib, M., and Kannel, W. B. (1977). The relationship of psychosocial factors to coronary heart disease: A further analysis of some data from the Western Collaborative Group Study.J. Chron. Dis. 30: 489–498.PubMedGoogle Scholar
  13. Musante, L., MacDougall, J. M., Dembroski, T. M., and Costa, P. T. (1989). Potential for hostility and dimensions of anger.Health Psychol. 8: 343–354.PubMedGoogle Scholar
  14. Ostfeld, A. M., Lebovits, B. S., Shekelle, R. B., and Paul, O. (1964). A prospective study of the relationship between personality and coronary heart disease.J. Chron. Dis. 17: 265–276.Google Scholar
  15. Pell, S., and Fayerweather, W. E. (1985). Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population, 1957–1983.N. Engl. J. Med. 312: 1005–1011.PubMedGoogle Scholar
  16. Powell, L. H., and Thoresen, C. E. (1988). Effects of Type A behavior counseling and severity of prior acute myocardial infarction on survival.Am. J. Cardiol. 62: 1159–1163.PubMedGoogle Scholar
  17. Rogot, E., and Hrubec, Z. (1989). Trends from mortality from coronary heart disease and stroke from U.S. Veterans: 1954–1979.J. Clin. Epidemiol. 42: 245–256.PubMedGoogle Scholar
  18. SAS Institute Inc. (1988).SAS/STAT User's Guide, Release 6.03 Edition. SAS Institute Inc., Cary, NC.Google Scholar
  19. Shocken, D. D., Worden, T., Greene, A. F., Harrison, E. F., and Spielberger, C. D. (1985). Age differences in the relationship between coronary artery disease, anxiety, and anger.Gerontologist 25: 36.Google Scholar
  20. Siegman, A. W., Dembroski, T. M., and Ringel, N. (1987a). Components of hostility and the severity of coronary artery disease.Psychosom. Med. 49: 127–135.PubMedGoogle Scholar
  21. Siegman, A. W., Feldstein, S., Tommaso, C. T., Ringel, N., and Lating, J. (1987b). Expressive vocal behavior and the severity of coronary atherosclerosis.Psychosom. Med. 49: 545–561.PubMedGoogle Scholar
  22. Siegman, A. W., Anderson, R. A., and Berger, T. (1990). The angry voice: Its effects on the experience of anger and cardiovascular reactivity.Psychosom. Med. 52: 631–643.PubMedGoogle Scholar
  23. Smith, T. W., and Frohm, K. D. (1985). What's so unhealthy about hostility? Construct validity and psychosocial correlates of the Cook and Medley Ho scale.Health Psychol. 4: 503–520.PubMedGoogle Scholar
  24. Spence, J. T., Helmreich, R. L., and Pred, R. S. (1987). Impatience versus achievement striving in the Type A pattern: differential effects on students' health and academic achievement.J. Appl Psychol. 72: 522–528.PubMedGoogle Scholar
  25. Spielberger, C. D., Jacobs, G. A., Russell, S., and Crane, R. S. (1983). Assessement of anger: The State-Trait Anger Scale. In Butcher, J. N., and Spielberger, C. D. (eds.),Advances in Personality Assessment, Vol. 2, Erlbaum, Hillsdale, NJ.Google Scholar
  26. Spielberger, C. D., Johnson, E. H., Russell, S. F., Crane, R. J., Jacobs, G. A., and Worden, T. J. (1985). The experience and expression of anger. In Chesney, M. A., and Rosenman, R. H. (eds.),Anger and Hostility in Cardiovascular and Behavioral Disorders, McGraw-Hill, New York, pp. 5–30.Google Scholar
  27. Suarez, E. C., and Williams, R. B. (1990). The relationships between dimensions of hostility and cardiovascular reactivity as a function of task characteristics.Psychosom. Med. 52: 558–570.PubMedGoogle Scholar
  28. Tennant, C. C., Langeluddecke, P. M., Fulcher, G., and Wilby, J. (1987). Anger and other psychological factors in coronary atherosclerosis.Psychol. Med. 17: 425–431.PubMedGoogle Scholar
  29. Williams, R. B. (1988). Coronary-prone behavior. In Houston, B. K., and Snyder, C. R. (eds.),Type A Behavior Pattern: Current Trends and Future Directions, Wiley, New York.Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Carlos F. Mendes de Leon
    • 1
  1. 1.Department of Epidemiology and Public HealthYale University School of MedicineNew Haven

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