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From the Behavioral Medicine Program (R.P.S., E.B., J.P.K., D.C., J.B.), Columbia-Presbyterian Medical Center; Department of Psychiatry (R.P.S., E.B., P.A.S., J.P.K.) and Division of Biostatistics, School of Public Health (E.B.), Columbia University; and Departments of Behavioral Medicine (R.P.S., J.P.K.) and Developmental Psychobiology (M.M.M.), New York State Psychiatric Institute, New York, New York.
Address reprint requests to: Richard P. Sloan, PhD, Columbia University, Box 427, 622 West 168th St., New York, NY 10032. Email: rps7{at}columbia.edu
OBJECTIVE: Although considerable evidence implicates hostility in the development of coronary artery disease (CAD), the pathogenic mechanisms remain poorly understood. We have developed a psychophysiological model that holds that altered autonomic nervous system function links psychological traits with CAD outcomes. In laboratory studies, stressors reduce high-frequency (HF) heart period variability, an index of cardiac vagal modulation. With ambulatory electrocardiographic recording, we demonstrated in a predominantly male sample that hostility was inversely associated with HF power, but only during waking hours. These findings are consistent with the hypothesis that hostile individuals experience multiple stressful interpersonal transactions each day, resulting in overall lower HF power during the day but not at night.
METHODS: To further evaluate this hypothesis, we screened 96 subjects using the Cook-Medley Hostility Scale and selected 15 men and 15 women representing a wide distribution of hostility. These subjects were studied in a laboratory session assessing reactivity to psychological and orthostatic challenges with continuous electrocardiographic, blood pressure, and respiration monitoring. We predicted that for men and women, hostility would be inversely related to reductions in HF power in response to challenge.
RESULTS: In response to mental stressors, all measures of heart period variability change were inversely related to hostility as predicted. No such relationships were found for responses to tilt. The data suggested a possible effect of gender on these relationships.
CONCLUSIONS: These data add to the growing body of evidence showing that hostility influences vagal modulation of the cardiovascular system and suggest that altered autonomic control is a pathogenic mechanism linking hostility and CAD.
Key Words: hostility • autonomic nervous system • heart period variability • reactivity.
Abbreviations: A/D = analog to digital; ANS = autonomic nervous system; BP = blood pressure; CAD = coronary artery disease; ECG = electrocardiographic; HF = high frequency; HPV = heart period variability; HR = heart rate; LF = low frequency; MF = mid frequency; MI = myocardial infarction; rMSSD = root-mean-squared successive difference; SDRR = standard deviation of RR intervals.
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