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Anxiety, Anger, and Mortality Risk among Survivors of Myocardial Infarction

Published:September 30, 2013DOI:https://doi.org/10.1016/j.amjmed.2013.07.022

      Abstract

      Background

      Although there is evidence that anxiety and anger are associated with a higher risk of cardiovascular events, studies examining the relationship between these stressors and prognosis following myocardial infarction have been mixed.

      Methods

      We conducted a prospective cohort study of 1968 participants (average age 60.2 years, 30.6% women) in the Determinants of Myocardial Infarction Onset Study recruited at the time of admission for myocardial infarction between 1989 and 1996. We used the state anxiety and anger subscales of the State-Trait Personality Inventory. Participants were followed for all-cause mortality through December 31, 2007 using the National Death Index. We constructed multivariable Cox proportional hazards models adjusted for demographic, behavioral, and clinical confounders and calculated hazard ratios (HR) and 95% confidence intervals (CI) to examine the relationship between high levels of anxiety and anger and all-cause mortality.

      Results

      Over 10 years of follow-up, 525 participants died. Compared with those scoring lower, an anxiety score >90th percentile was associated with a 1.31-times (95% CI, 0.93-1.84) higher mortality rate. The association was apparent in the first 3 years (HR 1.78; 95% CI 1.08-2.93), but not thereafter. Likewise, an anger score >90th percentile was associated with a 1.25-times (95% CI, 0.87-1.80) higher mortality rate. The association was higher in the first 3 years (HR 1.58; 95% CI, 0.91-2.74) than in subsequent years, but it was not statistically significant during either follow-up period.

      Conclusions

      In this study of myocardial infarction survivors, a high level of anxiety was associated with all-cause mortality, with the strongest association in the first 3 years of follow-up.

      Keywords

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      References

        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • et al.
        Executive summary: heart disease and stroke statistics–2012 update: a report from the American Heart Association.
        Circulation. 2012; 125: 188-197
        • Shen B.J.
        • Avivi Y.E.
        • Todaro J.F.
        • et al.
        Anxiety characteristics independently and prospectively predict myocardial infarction in men the unique contribution of anxiety among psychologic factors.
        J Am Coll Cardiol. 2008; 51: 113-119
        • Januzzi Jr., J.L.
        • Stern T.A.
        • Pasternak R.C.
        • DeSanctis R.W.
        The influence of anxiety and depression on outcomes of patients with coronary artery disease.
        Arch Intern Med. 2000; 160: 1913-1921
        • Kubzansky L.D.
        • Cole S.R.
        • Kawachi I.
        • et al.
        Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the normative aging study.
        Ann Behav Med. 2006; 31: 21-29
        • Mittleman M.A.
        • Maclure M.
        • Sherwood J.B.
        • et al.
        Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators.
        Circulation. 1995; 92: 1720-1725
        • Williams J.E.
        • Nieto F.J.
        • Sanford C.P.
        • Tyroler H.A.
        Effects of an angry temperament on coronary heart disease risk: the Atherosclerosis Risk in Communities Study.
        Am J Epidemiol. 2001; 154: 230-235
        • Boyle S.H.
        • Michalek J.E.
        • Suarez E.C.
        Covariation of psychological attributes and incident coronary heart disease in U.S. Air Force veterans of the Vietnam war.
        Psychosom Med. 2006; 68: 844-850
        • Shibeshi W.A.
        • Young-Xu Y.
        • Blatt C.M.
        Anxiety worsens prognosis in patients with coronary artery disease.
        J Am Coll Cardiol. 2007; 49: 2021-2027
        • Chida Y.
        • Steptoe A.
        The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence.
        J Am Coll Cardiol. 2009; 53: 936-946
        • Julkunen J.
        • Idanpaan-Heikkila U.
        • Saarinen T.
        Components of Type A behavior and the first-year prognosis of a myocardial infarction.
        J Psychosom Res. 1993; 37: 11-18
        • Frasure-Smith N.
        • Lesperance F.
        Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease.
        Arch Gen Psychiatry. 2008; 65: 62-71
        • Frasure-Smith N.
        • Lesperance F.
        • Talajic M.
        The impact of negative emotions on prognosis following myocardial infarction: is it more than depression?.
        Health Psychol. 1995; 14: 388-398
        • Benninghoven D.
        • Kaduk A.
        • Wiegand U.
        • et al.
        Influence of anxiety on the course of heart disease after acute myocardial infarction—risk factor or protective function?.
        Psychother Psychosom. 2006; 75: 56-61
        • Roest A.M.
        • Martens E.J.
        • Denollet J.
        • de Jonge P.
        Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis.
        Psychosom Med. 2010; 72: 563-569
        • Mayou R.A.
        • Gill D.
        • Thompson D.R.
        • et al.
        Depression and anxiety as predictors of outcome after myocardial infarction.
        Psychosom Med. 2000; 62: 212-219
        • Welin C.
        • Lappas G.
        • Wilhelmsen L.
        Independent importance of psychosocial factors for prognosis after myocardial infarction.
        J Intern Med. 2000; 247: 629-639
        • Lane D.
        • Carroll D.
        • Ring C.
        • et al.
        Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety.
        Psychosom Med. 2001; 63: 221-230
        • Nakamura S.
        • Kato K.
        • Yoshida A.
        • et al.
        Prognostic value of depression, anxiety, and anger in hospitalized cardiovascular disease patients for predicting adverse cardiac outcomes.
        Am J Cardiol. 2013; 111: 1432-1436
        • Stanley M.A.
        • Beck J.G.
        • Zebb B.J.
        Psychometric properties of four anxiety measures in older adults.
        Behav Res Ther. 1996; 34: 827-838
        • Spielberger C.D.
        • Jacobs G.
        • Crane R.
        • et al.
        Preliminary Manual for the State-Trait Personality Inventory.
        University of South Florida, Tampa1979
        • Krieger N.
        • Chen J.T.
        • Waterman P.D.
        • et al.
        Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US).
        J Epidemiol Community Health. 2003; 57: 186-199
        • Krieger N.
        • Chen J.T.
        • Waterman P.D.
        • et al.
        Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project.
        Am J Epidemiol. 2002; 156: 471-482
        • Rosenbloom J.I.
        • Wilker E.H.
        • Mukamal K.J.
        • et al.
        Residential proximity to major roadway and 10-year all-cause mortality after myocardial infarction.
        Circulation. 2012; 125: 2197-2203
        • Lane D.
        • Carroll D.
        • Ring C.
        • et al.
        In-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction.
        Int J Epidemiol. 2002; 31: 1179-1182
        • Rothman K.J.
        • Greenland S.
        • Lash T.L.
        Modern Epidemiology.
        3rd ed. Lippincott Williams & Wilkins, Philadelphia2008
        • Eng P.M.
        • Fitzmaurice G.
        • Kubzansky L.D.
        • et al.
        Anger expression and risk of stroke and coronary heart disease among male health professionals.
        Psychosom Med. 2003; 65: 100-110
        • Thomas S.A.
        • Friedmann E.
        • Wimbush F.
        • Schron E.
        Psychological factors and survival in the cardiac arrhythmia suppression trial (CAST): a reexamination.
        Am J Crit Care. 1997; 6: 116-126
        • Spielberger C.D.
        • Johnson E.H.
        • Russell S.F.
        • et al.
        The experience and expression of anger: construction and validation of an anger expression scale.
        in: Chesney M.A. Rosenman R.H. Anger and Hostility in Cardiovascular and Behavioral Disorders. Hemisphere, Washington, DC1985: 5-30
        • Denollet J.
        • Gidron Y.
        • Vrints C.J.
        • Conraads V.M.
        Anger, suppressed anger, and risk of adverse events in patients with coronary artery disease.
        Am J Cardiol. 2010; 105: 1555-1560
        • Haynes S.G.
        • Feinleib M.
        • Kannel W.B.
        The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease.
        Am J Epidemiol. 1980; 111: 37-58
        • Strike P.C.
        • Magid K.
        • Whitehead D.L.
        • et al.
        Pathophysiological processes underlying emotional triggering of acute cardiac events.
        Proc Natl Acad Sci U S A. 2006; 103: 4322-4327
        • Sparrenberger F.
        • Cichelero F.T.
        • Ascoli A.M.
        • et al.
        Does psychosocial stress cause hypertension? A systematic review of observational studies.
        J Hum Hypertens. 2009; 23: 12-19
        • Engebretson T.O.
        • Stoney C.M.
        Anger expression and lipid concentrations.
        Int J Behav Med. 1995; 2: 281-298
        • Williams J.E.
        • Din-Dzietham R.
        • Szklo M.
        Trait anger and arterial stiffness: results from the Atherosclerosis Risk in Communities (ARIC) study.
        Prev Cardiol. 2006; 9: 14-20
        • Watkins L.L.
        • Koch G.G.
        • Sherwood A.
        • et al.
        Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.
        J Am Heart Assoc. 2013; 2: e000068
        • Whalley B.
        • Thompson D.R.
        • Taylor R.S.
        Psychological interventions for coronary heart disease: Cochrane Systematic Review and Meta-analysis.
        Int J Behav Med. 2012 Nov 24; ([Epub ahead of print])
        • Lesperance F.
        • Frasure-Smith N.
        Negative emotions and coronary heart disease: getting to the heart of the matter.
        Lancet. 1996; 347: 414-415
        • Jones D.A.
        • West R.R.
        Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial.
        BMJ. 1996; 313: 1517-1521