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Outwardly expressed anger may predict coronary artery disease in women
Sex differences between suppressed and expressed anger may lead to CAD.
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Anger and hostility are not predictive factors for coronary artery disease in women; it depends on how women handle their emotions that predisposes them to risk, according to a report published in the Journal of Women’s Health.
“Only expressed anger predicts CAD in women, which is different from prior literature that identified also internalized anger and hostility as CAD risk factors in studies predominantly of men,” said C. Noel Bairey Merz, MD, medical director of the preventive and rehabilitative cardiac center and endowed chair and medical director of women’s health at Cedars-Sinai Medical Center, Los Angeles.
Results from previous studies have consistently shown that expressed anger and hostility is a strong risk factor for CAD in men. Bairey Merz and colleagues of the WISE (Women’s Ischemia Syndrome Evaluation) study analyzed a variety of measures related to anger, including cynicism, hostile temperament, aggression and suppressed anger to determine the pathophysiology of ischemic heart disease in women, and evaluate how sex-specific findings influence the clinical aspects of the disease.
From 1996 to 2000, the researchers enrolled 936 women referred for angiograms because of chest pain and suspected ischemia. This multicenter, long-term study included 636 women with suspected CAD referred to one of four sites for diagnostic coronary angiography: University of Florida, Gainesville; University of Pittsburgh; Allegheny General Hospital, Pittsburgh; and the University of Alabama, Birmingham.
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The researchers assessed CAD as the angiographic presence or absence of disease. They used the Cook-Medley Hostility Inventory, Spielberg Anger Expression Scale, cardiovascular symptom history and Duke Activity Status Index to determine hostility, anger, angina, symptoms and functional status of participants, according to the report.
The findings showed that only expressed anger, described as anger out on the rating scale, had predictive value (95% CI, 1.01-1.17), and only when increased age and history of diabetes and/or dyslipidemia risk factors were present. Anger out scores were associated with the presence of CAD (P<.05), according to the study. Anger and hostility were higher among women who also had increased CV symptoms.
Bairey Merz and colleagues also found no difference in anger and hostility across angina status; however, in women without CAD, those with non-anginal status had higher scores for anger out (P<.001), anger expression (P<.01), aggressive responding (P<.05) and hostile affect (P <.05), according to the study.
“For women, expressed anger was a strong risk factor for CAD. Differently from men, suppressed anger does not appear to be a risk factor in women,” said Bairey Merz, also a member of the Preventive Cardiology section on the Cardiology Today editorial board. “The new data, combined with our previous findings, indicate that anger and hostility in women, as in men, do tend to cluster with adverse risk factors.”
Although this study did not address the mental health issue of how to control anger emotions, she said the standard anger management practice suggests first describing what is seen and then outwardly saying what is felt to lead to a better resolution and express emotions in a nonhostile manner. Cultural and social acceptability or inherent biological factors may also influence differential sex reactions to anger emotions, and could be an important area of inquiry, according to Bairey Merz.
“Psychosocial factors are relevant to understanding coronary heart disease,” she said. “There are important sex and gender differences, and further research may elaborate how this is relevant to clinical practice. This study also points out the importance of addressing the concerns of women who must cope with atypical, unexplained symptoms and the psychological effects accompanying them.” – by Tara Grassia
For more information:
- Krantz DS, Olson MB, Francis JL, et al. Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: The Women’s Ischemia Syndrome Evaluation (WISE) Study. J Women’s Health. 2006;15:1214-1223.