Hostility and Coronary Artery Risk in Young Adults
Hostility and Coronary Artery Risk in Young Adults
abstract & commentary
Synopsis: This population-based study in young adults demonstrated a positive graded association between hostility scores at baseline and coronary artery calcification measured using EBCT 10 years later.
Source: Iribarren C, et al. JAMA 2000;283:2546-2551.
Coronary artery calcification detected by electron-beam computed tomography (EBCT) has been demonstrated to occur early in coronary artery plaque formation.1,2 It has been suggested that significant coronary artery calcification may be a stronger predictor of hemodynamically significant stenosis in the coronary arteries than are standard risk factors.3 Recent publications have reported that coronary calcification may be an accurate predictor of symptomatic coronary events such as sudden cardiac death, acute myocardial infarction, and unstable angina.4,5
Cook-Medley hostility assessment data were collected in 1985 and 1986 in 374 young patients aged 18-30 who participated in the Coronary Artery Risk Development in Young Adults (CARDIA). Iribarren and associates performed a logistic regression analysis adjusting for age, sex, race, and field location comparing those with hostility scores above and below the median of the distribution of the sample. This population-based study in young adults demonstrated a positive graded association between hostility scores at baseline and coronary artery calcification measured using EBCT 10 years later. Persons with baseline hostility scores above the median had at least a 2-fold greater prevalence of measurable coronary calcification (i.e., calcium score > 0) relative to those below the median. The results demonstrated that a high hostility level may predispose young adults to develop coronary artery calcification.
COMMENT BY HAROLD L. KARPMAN, MD, FACC, FACP
The results of this prospective cohort study clearly suggest that high hostility levels may be associated with an increased frequency of coronary artery calcification detected on EBCT and may, therefore, be an important contributor to early subclinical atherosclerotic coronary artery heart disease. Hostility is a clinical observation that can be quantified by the Cook-Medley questionnaire; however, the effects of hostility on coronary calcification may be due to multiple factors other than hostility such as greater alcohol and/or tobacco use, greater cardiovascular reactivity,6 early morning blood pressure surges,7 increased platelet activation,7,8 increased catecholamine levels, and/or other physiological mechanisms.9,10
In addition to hostility, it is important to recognize that proneness to anger places normotensive middle-aged men and women at significant risk for coronary artery disease, morbidity, and death independent of the established biological risk factors.11 Therapy directed at reducing hostility has been shown to reduce the risk of nonfatal reinfarction by more than 50%.12 It would, therefore, seem prudent to suggest appropriate counseling or psychiatric therapy for hostile (and/or angry) individuals in an attempt to reduce the incidence of coronary calcification and, more importantly, to reduce the risk of developing symptomatic coronary artery disease regardless of age.
References
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3. Kennedy J, et al. Am Heart J 1998;135:696-702.
4. Secci A, et al. Circulation 1997;96:112-129.
5. Lahad A, et al. J Psychosom Res 1997;43:183-195.
6. Guyll M, Contrada RJ. Health Psychol 1998;17:30-39.
7. Pasic J, et al. Am J Hypertens 1998;11:245-250.
8. Markovitz JH. Psychosom Med 1998;60:586-591.
9. Suarez EC, et al. Psychosom Med 1997;59:481-487.
10. Archer J. Br J Psychol 1991;82:1-28.
11. Williams JE, et al. Circulation 2000;101:2034-2039.
12. Friedman M, et al. Am Heart J 1986;112:653-665.
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