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Antagonistic Behavior, Dominance, Hostility, and Coronary Heart Disease

From the University of Maryland, Baltimore County (A.W.S., S.T.T.); and The Johns Hopkins School of Medicine (A.C.C., R.S.B.).

Address reprint requests to: Aron Wolfe Siegman, PhD, Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250.

PURPOSE: This study investigated the relationship between antagonistic behavior, dominance, attitudinal hostility, and coronary heart disease (CHD).

METHODS: One hundred one men and 95 women referred for thallium stress testing were administered the Structured Interview and the Cook-Medley Hostility Scale. The Hostile Behavior Index, derived from the Structured Interview and developed by Haney et al., served as an index of antagonism, and the frequency with which interviewees interrupted their interviewer served as a measure of dominance. On the basis of their medical history and thallium stress test results, patients were classified as having (N = 44) or not having (N = 99) CHD.

RESULTS AND CONCLUSIONS: Multivariate logistic regressions (with age, gender, disease, and lifestyle risk factors in the model) revealed that both the Hostile Behavior Index and dominance were significant independent risk factors for CHD (relative risk [RR] = 1.22 and 1.47, p < .03). Of the two Hostile Behavior Index component scores, indirect challenge and irritability, only the latter correlated significantly with CHD (RR = 1.27, p < .03). Separate logistic regressions for men and women suggest that subtle, indirect manifestations of antagonism confer CHD risk in women and that more overt expressions of anger confer risk in men. A significant univariate correlation between hostility scale scores and CHD became not significant when we adjusted for socioeconomic status.

Key Words: antagonism • irritability • dominance • hostility • socioeconomic status • coronaryheart disease

Abbreviations: CHD = coronary heart disease; CVR = cardiovascularreactivity; HBI = hostile behavior index; Ho = Cook-Medley Hostility Scale; MI = myocardial infarction; RR = relativerisk; SES = socioeconomic status; SI = structured interview; SPECT = single-photon emission computed tomography; STAXI =Spielberger State-Trait Anger Expression Inventory.

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