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From the Department of Psychiatry (S.H.B., R.B.W., B.H.B., I.C.S., M.J.H., J.C.B.), Duke University Medical Center, Durham, North Carolina; and the Division of Cardiology (D.B.M.), Department of Medicine, Durham, North Carolina.
Address correspondence and reprint requests to Stephen H. Boyle, PhD, Behavioral Medicine Research Center, Duke University Medical Center, Department of Psychiatry, Box 2969, Durham, NC. E-mail: shboyle{at}duke.edu
OBJECTIVE: This article presents a reanalysis of an earlier study that reported a nonsignificant relation between the 50-item Cook-Medley Hostility Scale (CMHS) and survival in a sample of coronary patients. Since publication of those results, there have been significant developments in the measurement of hostility that suggest that an abbreviated scale may be a better predictor of health outcomes. This study examined the ability of the total CMHS and an abbreviated form of the CMHS (ACM) to predict survival in a sample of patients with documented coronary artery disease (CAD) with increased statistical power.
METHODS: Nine hundred thirty-six patients (83% were male; mean age = 51.48) with CAD who were followed for an average of 14.9 years. The ACM consisted of the combination of the cynicism, hostile attribution, hostile affect, and aggressive responding subscales that were identified in an earlier study (Barefoot et al. [1989]) by a rational analysis of the item content. The relation between hostility and survival was examined with Cox proportional hazard models (hazard ratios [HRs] based on a two standard deviation difference).
RESULTS: Controlling for disease severity, the ACM was a significant predictor for both CHD mortality (HR = 1.33, p < .009) and total mortality (HR = 1.28, p < .02). The total CMHS was only a marginally significant predictor of either outcome (p values < 0.06).
CONCLUSION: The results of this study suggest that hostility is associated with poorer survival in CAD patients, and it may be possible to refine measures of hostility in order to improve prediction of health outcomes.
Key Words: hostility, • mortality, • coronary artery disease.
Abbreviations: CMHS = Cook-Medley Hostility Scale;; CHD = coronary heart disease;; CAD = coronary artery disease;; MI = myocardial infarction;; ACM = abbreviated Cook-Medley Hostility Scale;; SD = standard deviation;; HR = hazard ratio;; CI = confidence interval.
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