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Anger in Young Men and Subsequent Premature Cardiovascular Disease
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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