Author + information
- Received July 14, 2008
- Revision received November 25, 2008
- Accepted November 25, 2008
- Published online March 17, 2009.
- Yoichi Chida, MD, PhD* ( and )
- Andrew Steptoe, DPhil
- ↵*Reprint requests and correspondence:
Dr. Yoichi Chida, Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
Objectives This review aimed to evaluate the association between anger and hostility and coronary heart disease (CHD) in prospective cohort studies using quantitative methods.
Background The harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews have been inconclusive.
Methods We searched general bibliographic databases: MEDLINE, PsycINFO, Web of Science, and PubMed up to November 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations.
Results There were 25 studies (21 articles) investigating CHD outcomes in initially healthy populations and 19 studies (18 articles) of samples with existing CHD. Anger and hostility were associated with increased CHD events in the healthy population studies (combined hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.05 to 1.35, p = 0.008) and with poor prognosis in the CHD population studies (HR: 1.24; 95% CI: 1.08 to 1.42, p = 0.002). There were indications of publication bias in these reports, although the fail-safe numbers were 2,020 and 750 for healthy and disease population studies, respectively. Intriguingly, the harmful effect of anger and hostility on CHD events in the healthy populations was greater in men than women. In studies of participants with CHD at baseline that controlled fully for basal disease status and treatment, the association of anger and hostility with poor prognosis persisted.
Conclusions The current review suggests that anger and hostility are associated with CHD outcomes both in healthy and CHD populations. Besides conventional physical and pharmacological interventions, this supports the use of psychological management focusing on anger and hostility in the prevention and treatment of CHD.
Dr. Chida receives support from the Kanae Foundation for the Promotion of Medical Science and the Medical Research Council, United Kingdom. Dr. Steptoe receives support from the British Heart Foundation.
- Received July 14, 2008.
- Revision received November 25, 2008.
- Accepted November 25, 2008.
- American College of Cardiology Foundation