Document Detail

Anger, suppressed anger, and risk of adverse events in patients with coronary artery disease.
MedLine Citation:
PMID:  20494661     Owner:  NLM     Status:  MEDLINE    
Anger is associated with cardiovascular stress reactivity; however, little is known about the effect of suppressed anger in patients with coronary artery disease (CAD). We examined whether patients with CAD who suppress their anger are at risk of adverse events. At baseline, 644 patients with CAD completed measures of anger, anger-in (reluctance to express anger), and Type D personality (tendency to experience distress and to be inhibited). The combination of high anger and anger-in scores was used to identify the presence of suppressed anger. The end points were major adverse cardiac events (a composite of death, myocardial infarction, and revascularization) and cardiac death/myocardial infarction. After an average follow-up of 6.3 years (range 5 to 10), 126 patients (20%) had experienced a major adverse cardiac event, and 59 (9%) had experienced cardiac death or myocardial infarction. Anger (p = 0.009) and suppressed anger (p = 0.011) were associated with future major adverse cardiac events, but these associations were no longer significant after adjustment for clinical characteristics. However, suppressed anger remained associated with the more rigorous end point of cardiac death or myocardial infarction (odds ratio 2.87, 95% confidence interval 1.15 to 7.15, p = 0.024) after controlling for decreased systolic function, poor exercise tolerance, extent of CAD, and revascularization. Anger alone was not independently associated with this end point. Patients with a Type D personality had a fourfold rate of suppressed anger, and an adjustment for a Type D personality attenuated the observed association between suppressed anger and adverse cardiac events. In conclusion, patients with CAD who suppress their anger were at increased risk of adverse cardiac events, and this was accounted for by individual differences in Type D personality.
Johan Denollet; Yori Gidron; Christiaan J Vrints; Viviane M Conraads
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-10
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-07-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1555-60     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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MeSH Terms
Coronary Artery Disease / mortality,  psychology*
Follow-Up Studies
Middle Aged
Myocardial Infarction / psychology
Risk Assessment
Risk Factors
Stress, Psychological / complications

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