Author + information
- Received November 29, 2010
- Revision received April 19, 2011
- Accepted April 21, 2011
- Published online September 13, 2011.
- Jonathan D. Newman, MD, MPH⁎,
- Karina W. Davidson, PhD⁎,⁎ (, )
- Jonathan A. Shaffer, PhD⁎,
- Joseph E. Schwartz, PhD⁎,‡,
- William Chaplin, PhD†,
- Susan Kirkland, PhD§ and
- Daichi Shimbo, MD⁎
- ↵⁎Reprint requests and correspondence
: Dr. Karina W. Davidson, Columbia University College of Physicians and Surgeons, 622 West 168 Street, PH 9-948, New York, New York 10032
Objectives The aim of this study was to examine the relation between hostility and incident ischemic heart disease (IHD) and to determine whether observed hostility is superior to patient-reported hostility for the prediction of IHD in a large, prospective observational study.
Background Some studies have found that hostile patients have an increased risk of incident IHD. However, no studies have compared methods of hostility assessment or considered important psychosocial and cardiovascular risk factors as confounders. Furthermore, it is unknown whether all expressions of hostility carry equal risk or whether certain manifestations are more cardiotoxic.
Methods We assessed the independent relationship between baseline observed hostility and 10-year incident IHD in 1,749 adults of the population-based Canadian Nova Scotia Health Survey.
Results There were 149 (8.5%) incident IHD events (140 nonfatal, 9 fatal) during the 15,295 person-years of observation (9.74 events/1,000 person-years). Participants with any observed hostility had a greater risk of incident IHD than those without (p = 0.02); no such relation was found for patient-reported hostility. Those with any observed hostility had a significantly greater risk of incident IHD (hazard ratio: 2.06, 95% confidence interval: 1.04 to 4.08, p = 0.04), after adjusting for cardiovascular (age, sex, Framingham Risk Score) and psychosocial (depression, positive affect, patient-reported hostility, and anger) risk factors.
Conclusions The presence of any observed hostility at baseline was associated with a 2-fold increased risk of incident IHD over 10 years of follow-up. Compared with patient-reported measures, observed hostility is a superior predictor of IHD.
This work was supported by grants HL-091099, HL-080665, HL-076857, HL-084034, HL-088117, HL-072866, and T32 HL007854-15 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and by the National Health and Welfare of Canada, Ottawa, Ontario; the Nova Scotia Department of Health, Halifax, Nova Scotia; and the Heart and Stroke Foundation of New Brunswick, St. John, New Brunswick.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 29, 2010.
- Revision received April 19, 2011.
- Accepted April 21, 2011.
- American College of Cardiology Foundation