HONOLULU, April 24 – Anger and exhaustion may result in future heart attacks or sudden cardiac death, according to research presented today at the American Heart Association’s Asia Pacific Scientific Forum.
“To our knowledge, this is the first study to report the combined effects of these two psychological risk factors,” says Janice Williams, Ph.D., M.P.H., an epidemiologist at the Centers for Disease Control and Prevention in Atlanta and lead author of the study.
The study includes a bi-ethnic (black and white) sample of middle-aged men and women. It assessed the occurrence of heart attacks over nine years, a longer observation period than reported in previous studies.
Participants were members of the Atherosclerosis Risk in Communities (ARIC) Study. ARIC is a large prospective study of cardiovascular disease and its risk factors conducted in four U. S. communities: suburban Minneapolis, Minn.; Washington County, Md.; Forsyth County, N.C.; and Jackson, Miss.
From 1990-98, researchers followed 12,453 men and women who were between the ages of 45 and 64 and had not had a heart attack when the study began to assess the occurrence of heart attacks and sudden cardiac death.
Participants took the 10-item Spielberger Trait Anger Scale to test for levels of trait anger (TA) and the 21-item Maastricht Questionnaire to determine levels of vital exhaustion (VE). TA is identified as a person’s proneness to anger, and VE is defined as excessive fatigue, increased irritability and feelings of dejection or defeat.
Some sample items participants ranked in the anger survey include: “I feel annoyed when I am not given recognition for doing good work”; “I am quick-tempered”; and, “I get angry when I am slowed down by others’ mistakes.” Questions from the exhaustion survey included: “Have you experienced a feeling of hopelessness recently?”; “Do you ever wake up with a feeling of exhaustion and fatigue?”; and, “Do you have a feeling that you can’t cope?” TA and VE were ranked in groups of high, medium and low. The study found that persons who scored in high TA or high VE levels had a 42 percent greater long-term risk of heart attack or sudden cardiac death than those in the lowest tertile of each condition.
Furthermore, Williams says, “People who reported being highly prone to anger and also scored high for vital exhaustion were 69 percent more likely to have a heart attack or a sudden cardiac death than their counterparts who reported being less prone to anger and scored low for vital exhaustion.”
In sharp contrast, for both the low and medium levels of TA, the association between TA and VE was only appreciable when VE was in the highest tertile.
Researchers found the results were true even after taking into account several of the established biologic and sociodemographic risk factors for coronary heart disease, such as hypertension, smoking, gender, diabetes, low education and cholesterol levels. Williams says the results of the study confirm previous findings that support a positive association between psychological stressors and coronary heart disease. The study suggests that not only are anger and vital exhaustion short-term predictors of heart attack, but that they also may predict long-term heart attack risk.
“This study provides convincing evidence that high anger and high vital exhaustion preceded the heart attack and was not a consequence of it,” Williams says. “Epidemiologic research should continue to focus on the influence of psychological factors on coronary heart disease.”
Co-authors are David J. Couper, Ph.D.; Catherine P. Sanford, M.S.P.H.; Verna Lamar-Welch, Ph.D., M.P.H.; Herman A. Tyroler, M.D.; and Tom Mosely, Ph.D.
CONTACT:
Darcy Spitz or Carole Bullock
AHA News Media Relations
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Ph. 808-792-6515
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