Cynical distrust also associated with presence of coronary calcium
High hostility levels are associated with coronary artery calcification in young adults, according to an article in the May 17 issue of The Journal of the American Medical Association (JAMA).
Carlos Iribarren, M.D., M.P.H, Ph.D., from the Kaiser Permanente Medical Care Program, Oakland, Calif., and colleagues evaluated whether hostility, a previously reported predictor of clinical coronary artery disease, is associated with coronary artery calcification, which is a marker of subclinical atherosclerosis (hardening of the arteries before there are any symptoms). The study included 374 white and black men and women, aged 18 to 30 years at baseline measurement, who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study. There were follow-up examinations at five and 10 years after the baseline measurement. Hostility levels were measured by the Cook-Medley scale, a test consisting of 50 true-false questions. Coronary artery calcification was determined by electron-beam computed tomographic scans of the heart.
The researchers found that those subjects who had hostility scores above the median had about 2.5 times the risk of having any coronary artery calcification than those with scores below the median. Subjects who had hostility scores above the median also had nine times (9.56) the risk of having high coronary calcification levels than those with scores below the median. The association between hostility and calcification persisted after adjusting for demographic, lifestyle and physiological variables. The authors also report that cynical distrust, a subscale of hostility on the Cook-Medley test, was also associated with the presence of coronary calcium, although to a lesser degree.
"This prospective cohort study suggests that high hostility levels may contribute to early subclinical atherosclerotic coronary artery disease," the authors write. "Clinical trials are needed to test whether reduction in hostile attitudes and behaviors is an effective means of preventing atherosclerosis and thus ameliorating the burden of coronary disease."
According to background information in the study, hostility is a personality and character trait with attitudinal (cynicism and mistrust of others), emotional (anger) and behavioral (overt and repressed aggression) components. In other studies, high hostility levels have been related to increased risk of angiographically documented coronary atherosclerosis, hypertension (high blood pressure), development of coronary artery disease, and earlier death rates. According to the authors, several mechanisms have been proposed to explain why hostility may increase cardiovascular risk, including unhealthful lifestyle behaviors that are associated with hostility, such as smoking and alcohol use. However, chemical and hormonal effects from hostility may also be involved.
Editor's Note: This work was supported by grants from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Media Advisory: To contact Carlos Iribarren, M.D., M.P.H., Ph.D., call Laura Marshall of Kaiser Permanente at 510-271-5826.
(Journal of the American Medical Association. 2000; 283: 2546-2551)
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