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Trait Anger and the Metabolic Syndrome Predict Progression of Carotid Atherosclerosis in Healthy Middle-Aged Women

From the University of Helsinki, Department of Psychology, Helsinki, Finland (K.R.); and the University of Pittsburgh, Department of Psychiatry (K.A.M.), Department of Epidemiology (K.S.-T.), and Department of Psychology (L.H.K.), Pittsburgh, PA.

Address correspondence and reprint requests to Karen A. Matthews, PhD, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213. E-mail: matthewska{at}upmc.edu

OBJECTIVE: Hostility may predict coronary heart disease morbidity and mortality, as well as the metabolic syndrome. We tested to see if high levels of the attitudinal and emotional aspects of hostility lead to progression of carotid atherosclerosis in women and if the metabolic syndrome is a mediator of the association.

METHODS: Two hundred nine healthy women were followed during the perimenopausal and postmenopausal periods. Carotid artery ultrasound scans measured intima-media thickness (IMT) an average 7.4 (SD = 0.9, range 4.2–10.8) and 10.5 years (SD = 1.1, range = 6.9–13.0) after baseline. Hostility was measured at baseline and at the first carotid scan with Spielberger Trait Anger (being angry frequently) and Anger In (suppressing angry feelings) scales, and the Cook-Medley Hostility Inventory (hostile, cynical attitudes toward others). Metabolic syndrome was measured at the study entry and through the second carotid scan.

RESULTS: Baseline Trait Anger scores predicted an increase in IMT across 3 years (p < .05) and predicted the risk for developing the metabolic syndrome (p < .05). The risk for developing the metabolic syndrome, in turn, predicted an increase in IMT across 3 years (p < .05). Anger suppression and cynical attitudes were not associated with progression of carotid atherosclerosis.

CONCLUSION: Anger predicts progression of carotid atherosclerosis, and the metabolic syndrome may mediate this association. Women who experience angry feelings frequently may benefit from interventions aimed at reducing anger and reducing the metabolic syndrome components early in the natural history of atherosclerosis.

Key Words: anger, • carotid atherosclerosis, • metabolic syndrome, • women.

Abbreviations: CHD = coronary heart disease;; IMT = intima-media thickness;; HWS = healthy women study;; BP = blood pressure;; DBP = diastolic blood pressure;; SBP = systolic blood pressure;; HDL-C = high-density lipoprotein cholesterol;; ANCOVA = univariate analysis of covariance;; RMSEA = root mean square error of approximation.

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