Abstract
Cardiovascular disease (CVD) comprises diseases of the heart and the circulatory system, of which coronary heart disease (CHD) and stroke are major clinical end points. CVD is the leading cause of death in industrialized nations and, owing to its rapid acceleration in developing countries, is projected to become the number one killer worldwide. The established CVD risk factors are age, physical inactivity, diabetes mellitus, hypertension, elevated triglyceride levels, elevated low-density lipoprotein cholesterol levels, and cigarette smoking. Concern for the CHD morbidity and mortality burden and interest in effective prevention have stimulated debate over the degree to which new cases can be attributed to the traditional risk factors. Several studies have shown that after accounting for the traditional risk factors, unexplained variance in CHD remains. There has been growing interest in the influence of psychological factors in CVD. This chapter reviews primarily prospective, population-based studies on the relationship between anger/hostility and CVD. The results from these investigations confirm that trait anger/chronic hostility, anger expression, and acute anger episodes have positive predictive value for CVD – including new or recurrent events or atherosclerosis.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Anderson, D. E., Metter, E. J., Hougaku, H., & Najjar, S. S. (2006). Suppressed anger is associated with increased carotid arterial stiffness in older adults. American Journal of Hypertension, 19(11), 1129–1134.
Appels, A. (1997). Why do imminent victims of a cardiac event feel so tired? International Journal of Clinical Practice, 51(7), 447–450.
Beaglehole, R., & Magnus, P. (2002). The search for new risk factors for coronary heart disease: Occupational therapy for epidemiologists? International Journal of Epidemiology, 31(6), 1117–1122.
Black, P. H. (2003). The inflammatory response is an integral part of the stress response: Implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome X. Brain, Behavior, and Immunity, 17(5), 350–364.
Bleil, M. E., McCaffery, J. M., Muldoon, M. F., Sutton-Tyrrell, K., & Manuck, S. B. (2004). Anger-related personality traits and carotid artery atherosclerosis in untreated hypertensive men. Psychosomatic Medicine, 66(5), 633–639.
Boltwood, M. D., Taylor, C. B., Burke, M. B., Grogin, H., & Giacomini, J. (1993). Anger report predicts coronary artery vasomotor response to mental stress in atherosclerotic segments. American Journal of Cardiology, 72(18), 1361–1365.
Bunde, J., & Suls, J. (2006). A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors. Health Psychology, 25(4), 493–500.
Castiglioni, A. (1947). A history of medicine (pp. 596–598). New York: Alfred A. Knopf.
Chang, P. P., Ford, D. E., Meoni, L. A., Wang, N., & Klag, M. J. (2002). Anger in young men and subsequent premature cardiovascular disease: The Precursors Study. Archives of Internal Medicine, 162(8), 901–906.
Chaput, L. A., Adams, S. H., Simon, J. A., Blumenthal, R. S., Vittinghoff, E., Lin, F., et al., for the Heart Estrogen/progestin Replacement Study (HERS) Research Group. (2002). Hostility predicts recurrent events among postmenopausal women with coronary heart disease. American Journal of Epidemiology, 156(12), 1092–1099.
Coccaro, E. F. (2006). Association of C-reactive protein elevation with trait aggression and hostility in personality disordered subjects: A pilot study. Journal of Psychiatric Research, 40(5), 460–465.
Eaker, E. D., Sullivan, L. M., Kelly-Hayes, M., D’Agostino, R. B., & Benjamin, E. J. (2004). Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation, 109(10), 1267–1271.
Eng, P. M., Fitzmaurice, G., Kubzansky, L. D., Rimm, E. B., & Kawachi, I. (2003). Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosomatic Medicine, 65(1), 100–110.
Everson, S. A., Kaplan, G. A., Goldberg, D. E., Lakka, T. A., Sivenius, J., & Salonen, J. T. (1999). Anger expression and incident stroke. Prospective evidence from the Kuopio Ischemic Heart Disease Study. Stroke, 30(8), 523–528.
Everson, S. A., Kauhanen, J., Kaplan, G. A., Goldberg, D. E., Julkunen, J., Tuomilehto, J., et al. (1997). Hostility and increased risk of mortality and acute myocardial infarction: The mediating role of behavioral risk factors. American Journal of Epidemiology, 146(2), 142–152.
Everson-Rose, S. A., Lewis, T. T., Karavolos, K., Matthews, K. A., Sutton-Tyrrell, K., & Powell, L. H. (2006). Cynical hostility and carotid atherosclerosis in African American and white women: The Study of Women’s Health Across the Nation (SWAN) Heart Study. American Heart Journal, 152(5), 982.e7–982.e13.
Fredrickson, B. L., Maynard, K. E., Helms, M. J., Haney, T. L., Siegler, I. C., & Barefoot, J. C. (2000). Hostility predicts magnitude and duration of blood pressure response to anger. Journal of Behavioral Medicine, 23(3), 229–243.
Friedman, M., & Rosenman, R. H. (1959). Association of specific overt behavior pattern with blood and cardiovascular findings: Blood cholesterol level, blood clotting time, incidence of arcus senilus, and clinical coronary artery disease. JAMA, 2169(12), 1286–1296.
Gallacher, J. E. J., Yarnell, J. W. G., Sweetnam, P. M., Elwood, P. C., & Stansfeld, S. A. (1999). Anger and incident heart disease in the caerphilly study. Psychosomatic Medicine, 61(4), 446–453.
Ghiadoni, L., Donald, A. E., Cropley, M., Mullen, M. J., Oakley, G., Taylor, M., et al. (2000). Mental stress induces transient endothelial dysfunction in humans. Circulation, 102(20), 2473–2478.
Goodman, M., Quigley, J., Moran, G., Meilman, H., & Sherman, M. (1996). Hostility predicts restenosis after percutaneous transluminal coronary angioplasty. Mayo Clinic Proceedings, 71(8), 729–734.
Graham, J. E., Robles, T. F., Kiecolt-Glaser, J. K., Malarkey, W. B., Bissell, M. G., & Glaser, R. (2006). Hostility and pain are related to inflammation in older adults. Brain, Behavior, and Immunity, 20(4), 389–400.
Haas, D. C., Chaplin, W. F., Shimbo, D., Pickering, T. G., Burg, M., & Davidson, K. W. (2005). Hostility is an independent predictor of recurrent coronary heart disease events in men but not women: Results from a population based study. Heart, 91(12), 1609–1610.
Harris, K. F., Matthews, K. A., Sutton-Tyrrell, K., & Kuller, L. H. (2003). Associations between psychological traits and endothelial function in postmenopausal women. Psychosomatic Medicine, 65(3), 402–409.
Hearn, M. D., Murray, D. M., & Luepker, R. V. (1989). Hostility, coronary heart disease, and total mortality: A 33-year follow-up study of university students. Journal of Behavioral Medicine, 12(2), 105–121.
Helmer, D. C., Ragland, D. R., & Syme, S. L. (1991). Hostility and coronary artery disease. American Journal of Epidemiology, 133(2), 112–122.
Iribarren, C., Sidney, S., Bild, D. E., Liu, K., Markovitz, J. H., Roseman, J. M., et al. (2000). Association of hostility with coronary artery calcification in young adults: The CARDIA Study. JAMA, 283(19), 2546–2551.
Julkunen, J., Salonen, R., Kaplan, G. A., Chesney, M. A., & Salonen, J. T. (1994). Hostility and the progression of carotid atherosclerosis. Psychosomatic Medicine, 56, 519–525.
Kawachi, I., Sparrow, D., Spiro, A., III, Vokonas, P., & Weiss, S. T. (1996). A prospective study of anger and coronary heart disease. Circulation, 94(9), 2090–2095.
Koh, K. B., Choe, K. O., & An, S. K. (2003). Anger and coronary calcification in individuals with and without risk factors of coronary artery disease. Yonsei Medical Journal, 44(5), 793–799.
Kop, W. J. (1997). Acute and chronic psychological risk factors for coronary syndromes: Moderating effects of coronary artery disease severity. Journal of Psychosomatic Research, 43(2), 167–181.
Kovach, J. A., Nearing, B. D., & Verrier, R. L. (2001). Angerlike behavioral state potentiates myocardial ischemia-induced T-wave alternans in canines. Journal of the American College of Cardiology, 37(6),1719–1725.
Levenson, J. W., Skerrett, P. J., & Gaziano, J. M. (2002). Reducing the global burden of cardiovascular disease: The role of risk factors. Preventive Cardiology, 5(4), 188–199.
Markovitz, J. H., Matthews, K. A., Kiss, J., & Smitherman, T. C. (1996). Effects of hostility on platelet reactivity to psychological stress in coronary heart disease patients and in healthy controls. Psychosomatic Medicine, 58(2), 143–149.
Matthews, K. A., Glass, D. C., Rosenman, R. H., & Bortner, R. W. (1977). Competitive drive, pattern A, and coronary artery disease: A further analysis of some data from the Western Collaborative Group Study. Journal of Chronic Diseases, 30(8), 489–498.
Matthews, K. A., Gump, B. B., Harris, K. F., Haney, T. L., & Barefoot, J. C. (2004). Hostile behaviors predict cardiovascular mortality among men enrolled in the Multiple Risk Factor Intervention Trial. Circulation, 109(1), 66–70.
Matthews, K. A., Owens, J. F., Kuller, L. H., Sutton-Tyrrell, K., & Jansen-McWilliams, L. (1998). Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women? Psychosomatic Medicine, 60(5), 633–638.
McCranie, E. W., Watkins, L. O., Brandsma, J. M., & Sisson, B. D. (1986). Hostility, coronary heart disease (CHD) incidence, and total mortality: Lack of association in a 25-year follow-up study of 478 physicians. Journal of Behavioral Medicine, 9(2), 119–125.
Meesters, C. M. G., & Smulders, J. (1994). Hostility and myocardial infarction in men. Journal of Psychosomatic Research, 38(7), 727–734.
Mendes de Leon, C. F., Kop, W. J., de Swart, H. B., Bar, F. W., & Appels, A. P. (1996). Psychosocial characteristics and recurrent events after percutaneous transluminal coronary angioplasty. American Journal of Cardiology, 77(4), 252–255.
Miller, G. E., Freedland, K. E., Carney, R. M., Stetler, C. A., & Banks, W. A. (2003). Cynical hostility, depressive symptoms, and the expression of inflammatory risk markers for coronary artery disease. Journal of Behavioral Medicine, 26(6), 501–515.
Miller, T. Q., Smith, T. W., Turner, C. W., Guijarro, M. L., & Hallet, A. J. (1996). A meta-analytic review of research on hostility and physical health. Psychological Bulletin, 119(2), 322–348.
Mittleman, M. A., Maclure, M., Sherwood, J. B., Mulry, R. P., Tofler, G. H., Jacobs, S. C., et al., for the Determinants of Myocardial Infarction Onset Study Investigators. (1995). Triggering of acute myocardial infarction onset by episodes of anger. Circulation, 92(7), 1720–1725.
Nelson, T. L., Palmer, R. F., & Pedersen, N. L. (2004). The metabolic syndrome mediates the relationship between cynical hostility and cardiovascular disease. Experimental Aging Research, 30(2), 163–177.
Niaura, R., Banks, S. M., Ward, K. D., Stoney, C. M., Spiro, A., III, Aldwin, C. M., et al. (2000). Hostility and the metabolic syndrome in older males: The Normative Aging Study. Psychosomatic Medicine, 62(1), 7–16.
O’Malley, P. G., Jones, D. L., Feuerstein, I. M., & Taylor, A. J. (2000). Lack of correlation between psychological factors and subclinical coronary artery disease. The New England Journal of Medicine, 343(18), 1298–1304.
Pope, M. K., & Smith, T. W. (1991). Cortisol excretion in high and low cynically hostile men. Psychosomatic Medicine, 53(4), 386–392.
Räikkönen, K., Matthews, K. A., Sutton-Tyrrell, K., & Kuller, L. H. (2004). Trait anger and the metabolic syndrome predict progression of carotid atherosclerosis in healthy middle-aged women. Psychosomatic Medicine, 66(6), 903–908.
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 99(16), 2192–2217.
Rutledge, T., Reis, S. E., Olson, M., Owens, J., Kelsey, S. F., Pepine, C. J., et al. (2001). Psychosocial variables are associated with atherosclerosis risk factors among women with chest pain: The WISE Study. Psychosomatic Medicine, 63(2), 282–288.
Schum, J. L., Jorgensen, R. S., Verhaeghen, P., Sauro, M., & Thibodeau, R. (2003). Trait anger, anger expression, and ambulatory blood pressure: A meta-analytic review. Journal of Behavioral Medicine, 26(5), 395–415.
Sherwood, A., Johnson, K., Blumenthal, J. A., & Hinderliter, A. L. (1999). Endothelial function and hemodynamic responses during mental stress. Psychosomatic Medicine, 61(3), 365–370.
Siegler, I. C., Costa, P. T., Brummett, B. H., Helms, M. J., Barefoot, J. C., Williams, R. B., et al. (2003). Patterns of change in hostility from college to midlife in the UNC Alumni Heart Study predict high-risk status. Psychosomatic Medicine, 65(5), 738–745.
Skantze, H. B., Kaplan, J., Pettersson, K., Manuck, S., Blomqvist, N., Kyes, R., et al. (1998). Psychosocial stress causes endothelial injury in cynomolgus monkeys via β1-adrenoceptor activation. Atherosclerosis, 136(1), 153–161.
Suarez, E. C. (2003). Plasma interleukin-6 is associated with psychological coronary risk factors: Moderation by use of multivitamin supplements. Brain, Behavior, and Immunity, 17(4), 296–303.
Suarez, E. C. (2003). Joint effect of hostility and severity of depressive symptoms on plasma interleukin-6 concentration. Psychosomatic Medicine, 65(4), 523–527.
Suarez, E. C. (2004). C-reactive protein is associated with psychological risk factors of cardiovascular disease in apparently healthy adults. Psychosomatic Medicine, 66(5), 684–691.
Suarez, E. C., Kuhn, C. M., Schanberg, S. M., Williams, R. B., Jr., & Zimmerman, E. A. (1998). Neuroendocrine, cardiovascular, and emotional responses of hostile men: The role of interpersonal challenge. Psychosomatic Medicine, 60(1), 78–88.
Suarez, E. C., Lewis, J. G., Krishnan, R. R., & Young, K. H. (2004). Enhanced expression of cytokines and chemokines by blood monocytes to in vitro lipopolysaccharide stimulation are associated with hostility and severity of depressive symptoms in healthy women. Psychoneuroendocrinology, 29(9), 1119–1128.
Suarez, E. C., Lewis, J. G., & Kuhn, C. (2002). The relation of aggression, hostility, and anger to lipopolysaccharide-stimulated tumor necrosis factor (TNF)-alpha by blood monocytes from normal men. Brain, Behavior, and Immunity, 16(6), 675–684.
Verrier, R. L., Hagestad, E. L., & Lown, B. (1987). Delayed myocardial ischemia induced by anger. Circulation, 75(1), 249–254.
Williams, J. E., Couper, D. J., Din-Dzietham., R., Nieto, F. J., & Folsom, A. R. (2007). Race-gender differences in the association of trait anger to subclinical carotid artery atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study. American Journal of Epidemiology, 165(11), 1296–1304.
Williams, J. E., Din-Dzietham, R., & Szklo, M. (2006). Trait anger and arterial stiffness: Results from the Atherosclerosis Risk in Communities (ARIC) Study. Preventive Cardiology, 9(1), 14–20.
Williams, J. E., Nieto, F. J., Sanford, C. P., Couper, D. J., & Tyroler, H. A. (2002). The association between trait anger and incident stroke risk: The Atherosclerosis Risk in Communities (ARIC) Study. Stroke, 33(1), 13–20.
Williams, J. E., Nieto, F. J., Sanford, C. P., & Tyroler, H. A. (2001). Effects of an angry temperament on coronary heart disease risk: The Atherosclerosis Risk In Communities (ARIC) Study. American Journal of Epidemiology, 154(3), 230–235.
Williams, J. E., Paton, C. C., Siegler, I. C., Eigenbrodt, M. L., Nieto, F. J., & Tyroler, H. A. (2000). Anger proneness predicts incident coronary heart disease risk: Prospective analysis from the Atherosclerosis Risk in Communities (ARIC) Study. Circulation, 101(17), 2034–2039.
Yan, L. L., Liu, K., Matthews, K. A., Daviglus, M. L., Ferguson, T. F., & Kiefe, C. I. (2003). Psychosocial factors and risk of hypertension: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA, 290(16), 2138–2148.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Williams, J.E. (2010). Anger/Hostility and Cardiovascular Disease. In: Potegal, M., Stemmler, G., Spielberger, C. (eds) International Handbook of Anger. Springer, New York, NY. https://doi.org/10.1007/978-0-387-89676-2_25
Download citation
DOI: https://doi.org/10.1007/978-0-387-89676-2_25
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-89675-5
Online ISBN: 978-0-387-89676-2
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)