Anger, suppressed anger, and risk of adverse events in patients with coronary artery disease.
Level 3 - non-randomized controlled study
Prospective cohort follow-up study
PubMed 20494661 · doi:10.1016/j.amjcard.2010.01.015
What was done
A prospective cohort study followed 644 patients with coronary artery disease (CAD) who completed baseline measures of anger, anger-in (reluctance to express anger), and Type D personality (distress and social inhibition). Suppressed anger was defined as having high scores on both anger and anger-in. Patients were followed for an average of 6.3 years (range 5 to 10 years) for major adverse cardiac events (composite of death, myocardial infarction, and revascularization) and cardiac death or myocardial infarction.
What was found
During follow-up, 126 patients (20%) had a major adverse cardiac event, and 59 (9%) experienced cardiac death or myocardial infarction. Initial associations of anger (p = 0.009) and suppressed anger (p = 0.011) with major adverse cardiac events were not significant after adjustment for clinical characteristics. However, suppressed anger remained independently associated with cardiac death or myocardial infarction (odds ratio 2.87, 95% confidence interval 1.15 to 7.15, p = 0.024) after adjusting for systolic function, exercise tolerance, extent of CAD, and revascularization. Anger alone showed no independent association with this endpoint. Patients with a Type D personality had a fourfold rate of suppressed anger, and adjusting for Type D personality attenuated the association between suppressed anger and adverse cardiac events.
Why it matters
The study shows that anger suppression, rather than anger alone, predicts hard cardiovascular endpoints in CAD patients, an association heavily linked to Type D personality traits.
Limits
The abstract does not report baseline demographic characteristics, medication adherence, or lifestyle factors during follow-up. Psychological traits were assessed only at baseline, and the hard event count was modest (59 events), which resulted in relatively wide confidence intervals.
Cited by
- partial In research on Type A personality and cardiovascular disease, individuals who suppress and hold their emotions inside have higher early heart attack mortality compared to those who express emotions outwardly.