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Hostility Scores Are Associated With Increased Risk of Cardiovascular Events in Women Undergoing Coronary Angiography: A Report from the NHLBI-Sponsored WISE Study

From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (M.B.O., S.F.K., G.L.G., C.K.M.); The Uniformed Services University of Health Sciences, Bethesda, Maryland (D.S.K.); Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL (C.J.P., E.H.); National Institute of Medicine, NHLBI, Bethesda, Maryland (G.S.); Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (W.J.R.); and Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.N.B.M.)

Address correspondence and reprint requests to Marian B. Olson, Graduate School of Public Health, Room 127 Parran Hall, University of Pittsburgh, 130 Desoto Street, Pittsburgh, PA 15261. E-mail: molson{at}hs.pitt.edu

Objective: To evaluate hostility-related personality traits assessed by the Cook Medley Hostility Inventory and to relate these to the occurrence of adverse cardiac events in women with suspected myocardial ischemia.

Methods: The cohort included 506 women with suspected coronary artery disease from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. We examined individual components of the Cook Medley Hostility Score (CMHS) measuring cynicism, hostile affect, and aggressive responding, and a total CMHS (sum of these three) and associations with adverse events (defined as hospitalization for angina, nonfatal myocardial infarction, stroke, congestive heart failure (CHF) other vascular events and death) during 3 to 6 years follow-up using Cox proportional hazard modeling.

Results: Women with adverse events had higher total CMHS (10.6 ± 5.5) than women without any of these events (9.2 ± 5.1) p = .02. They also had poorer survival by Kaplan-Meier analysis (log-rank p < .05). Unadjusted Cox models showed that the individual scores of cynicism and aggressive responding and the total CMHS were associated with more adverse events (all p < .05). Women with total CMHS above the median had a 35% increase risk of an adverse event in comparison to women with lower scores. In a risk-adjusted Cox model, the hazard ratio for an adverse event was 1.5 (p = .03) for women with total CMHS above the median.

Conclusion: In this cohort of women with suspected myocardial ischemia, higher Cook Medley scores reflecting cynicism, hostile affect, and aggressive responding were associated with poorer 3 to 6 year event-free survival and a higher risk of adverse events. After adjusting for risk factors and CAD, the association with risk for adverse events increased.

Key Words: hostility • cardiovascular events • women

Abbreviations: CAD = coronary artery disease; CHF = congestive heart failure, HT = hormone therapy; WISE = Women’s Ischemia Syndrome Evaluation; CHD = coronary heart disease; MI = myocardial infarction; HERS = Heart and Estrogen/Progestin Replacement Study; NHLBI = National Heart, Lung, and Blood Institute; CMHS = Cook Medley Hostility Score.

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