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From the Behavioral Physiology Laboratory, Department of Psychology, University of Pittsburgh, Pittsburgh, PA (M.E.B., S.B.M.); the Center for Clinical Pharmacology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA (M.F.M.); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (K.S.-T.); and the Centers for Behavioral and Preventive Medicine, Brown Medical School and the Miriam Hospital, Providence, RI (J.M.M.).
Address correspondence to Maria E. Bleil, MS, Behavioral Physiology Laboratory, 506 Old Engineering Hall, University of Pittsburgh, 4015 O’Hara St., Pittsburgh, PA 15260. E-mail: bleil{at}pitt.edu
OBJECTIVE: To determine whether anger-related personality traits are associated with carotid artery atherosclerosis in untreated hypertensive patients.
METHODS: Study participants were 237 men with elevated blood pressure (systolic 140–180 mm Hg and/or diastolic 90–110 mm Hg) but untreated for hypertension. Average age was 56 years; 80% of subjects were white. Eighty-six percent had no history of antihypertensive treatment, and the remainder reported median lifetime treatment exposure of 4 months. Subjects were administered the Spielberger State-Trait Anger Expression Inventory, which measures tendencies to experience anger (Trait Anger) and modes of anger expression (Anger-In, Anger-Out, Anger-Control). Mean and maximum intima-medial thickness (IMT) and plaque occurrence in the extracranial carotid arteries were measured by B-mode ultrasonography.
RESULTS: Trait Anger was marginally (p = .065) related to mean and significantly (p < .05) related to maximum IMT, independent of standard risk factors (age, race, body mass index, education, smoking, fasting glucose, total:high-density lipoprotein cholesterol ratio). A component of Trait Anger, Angry Temperament, similarly predicted mean (p = .062) and maximum IMT (p < .05) and plaque occurrence (p < .05). Anger-Out predicted both mean and maximum IMT (p values <.01).
CONCLUSIONS: An antagonistic disposition (Trait Anger), particularly a tendency to experience anger on minimal provocation (Angry Temperament) and a propensity to express anger outwardly (Anger-Out), are associated with heightened carotid atherosclerosis. These findings suggest that recently reported prospective associations between these anger dimensions and incident cerebrovascular disease may be mediated, in part, by increased atherosclerotic disease.
Key Words: hypertension • carotid artery atherosclerosis • stroke • anger
Abbreviations: ARIC = Atherosclerosis Risk in Communities;; HDL = high-density lipoprotein;; IMT = intima-medial thickening;; REACT = University of Pittsburgh Reactivity and Cardiovascular Risk Trial;; BP = blood pressure;; SBP = systolic blood pressure;; DBP = diastolic blood pressure;; BMI = body mass index.
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