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The Precursors Study

Patricia P. Chang, MD, MHS; Daniel E. Ford, MD, MPH; Lucy A. Meoni, ScM; Nae-Yuh Wang, PhD; Michael J. Klag, MD, MPH

Arch Intern Med. 2002;162:901-906.

Background  Anger can trigger myocardial ischemia and may be an independent risk factor for coronary heart disease, but its effect on early compared with late onset of disease is unclear.

Methods  We performed a prospective study of 1055 men followed up for 32 to 48 years to examine the risk of premature and total cardiovascular disease (CVD) associated with anger responses to stress during early adult life. Highest level of anger was defined as a self-report of all 3 possible anger reactions to stress (expressed or concealed anger, gripe sessions, and irritability) on a checklist questionnaire administered in medical school. Premature disease was defined as events before age 55 years.

Results  During a median follow-up period of 36 years, 205 men developed CVD (cumulative incidence at 76 years, 34.5%), of whom 77 men developed premature disease (cumulative incidence before 55 years, 7.9%). The highest level of anger was associated with an increased risk of premature CVD (adjusted relative risk, 3.1; 95% confidence interval, 1.1-8.6), including premature coronary heart disease (relative risk, 3.5; 95% confidence interval, 1.1-11.8) and premature myocardial infarction (relative risk, 6.4; 95% confidence interval, 1.8-22.3), compared with lower levels of anger. When CVD events after age 55 years were included, there was no longer a statistically significant association between anger and CVD.

Conclusion  High level of anger in response to stress in young men is associated with an increased risk of subsequent premature CVD, particularly myocardial infarction.

From the Departments of Medicine (Drs Chang, Ford, Wang, and Klag and Ms Meoni), Epidemiology (Drs Chang, Ford, and Klag), Health Policy and Management (Drs Ford and Klag), and Biostatistics (Ms Meoni), The Johns Hopkins University School of Medicine and School of Hygiene and Public Health, Baltimore, Md.

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