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The ARIC Study

Anger and Coronary Heart Disease: Epidemiologic Evidence from the Atherosclerosis Risk in Communities (ARIC) Study Janice E. Williams, PhD, MPH Centers for Disease Control and Prevention. The ARIC Study. Two research arms Cohort Community morbidity/mortality surveillance. Types of Anger.

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The ARIC Study

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  1. Anger and Coronary Heart Disease: Epidemiologic Evidence fromthe Atherosclerosis Risk in Communities (ARIC) StudyJanice E. Williams, PhD, MPHCenters for Disease Control and Prevention

  2. The ARIC Study • Two research arms • Cohort • Community morbidity/mortality surveillance

  3. Types of Anger • Anger experience • Transitory state (state anger) • Stable and general predisposition to experience anger (trait anger)

  4. Types of Anger • Anger expression • Anger in • Anger out • Anger control

  5. Trait Anger • Subtypes • Temperament • Reaction

  6. Anger and CHD Studies • Have employed the following study designs to provide evidence of an association • cross-sectional • prospective • laboratory/clinical

  7. Anger and CHD: ARIC Study • Relationship of overall trait anger and subtypes to • CHD (revascularization procedures, silent MI, acute MI/fatal CHD)

  8. Methods • 13,000 black and white men and women, aged 48 - 67, free of clinically manifest CHD • Completed Spielberger Trait Anger Scale

  9. Methods • Followed from 1990 - 1995 for the occurrence of CHD (revascularization procedures, silent MI, acute MI/fatal CHD)

  10. Spielberger Trait Anger Scale • I am quick tempered. • I have a fiery temper. • I am a hotheaded person. • I get angry when I am slowed down by others’ mistakes.

  11. Spielberger Trait Anger Scale (continued) • I feel annoyed when I am not given recognition for doing good work. • I fly off the handle. • When I get angry, I say nasty things.

  12. Spielberger Trait Anger Scale (continued) • It makes me furious when I am criticized in front of others. • When I get frustrated, I feel like hitting someone.

  13. Spielberger Trait Anger Scale (continued) • I feel infuriated when I do a good job and get a poor evaluation.

  14. Trait Anger-Temperament Subscale • I am quick tempered. • I have a fiery temper. • I am a hotheaded person. • I fly off the handle.

  15. Trait Anger - Reaction Subscale • I get angry when I am slowed down by others’ mistakes. • I feel annoyed when I am not given recognition for doing good work.

  16. Trait Anger - Reaction Subscale (continued) • It makes me furious when I am criticized in front of others. • I feel infuriated when I do a good job and get a poor evaluation.

  17. Spielberger Trait Anger Scale • Coding • 1) Almost never • 2) Sometimes • 3) Often • 4) Almost always

  18. Statistical Analyses • Means and percentages to describe the population by CHD risk factors. • -2 log likelihood tests to assess interactions of covariates with anger.

  19. Statistical Analyses (continued) • Proportional hazards regression models to assess anger-CHD association. • Kaplan-Meier product limit method to assess probabilities of CHD event-free survival.

  20. Covariates • Drinking • Smoking • Diabetes • Age • Race • Gender • Education • Waist-to-hip ratio • LDL-and HDL-cholesterol

  21. Results • Compared to their low-anger counterparts, persons high in trait anger were more likely to: • be smokers and drinkers • be heavier • have less formal education

  22. Multivariate-adjusted hazard ratios (95% C.I.) for the association between overall trait anger and CHD risk _ _ _ _ _ _ _ _

  23. Multivariate-adjusted hazard ratios (95% C.I.) for the association between trait anger-temperament and CHD risk _ _ _ _ _ _ _ _

  24. Multivariate-adjusted hazard ratios (95% C.I.) for the association between trait anger-reaction and CHD risk _ _ _ _

  25. Summary • Overall trait anger was positively associated with risk of both combined CHD and of “hard” events (acute MI/fatal CHD) among normotensive individuals.

  26. Summary • Similarly, trait anger-temperament was positively associated with combined CHD and with “hard” events (acute MI/fatal CHD) among normotensive individuals.

  27. Summary • No statistically significant association was observed between trait anger-reaction and CHD.

  28. Conclusions • A fiery temper predisposes middle-aged normotensive persons to a greater risk of CHD than anger aroused in reaction to frustration, criticism, or unfair treatment.

  29. The Mechanism • High-anger persons, compared to their low-anger counterparts, may be more likely to engage in unhealthy behaviors that place them at risk for CHD.

  30. The Mechanism • Direct pathophysiological effects via heightened sympathetic arousal and neuroendocrine activation.

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