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Hostility predicts recurrent events among postmenopausal women with coronary heart disease
Lily A Chaput1, Sally H Adams, Joel A Simon
1Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 94115, USA. lily.chaput@ucsfmedctr.org
Insights
Hostility is an independent risk factor for recurrent coronary heart disease (CHD) events in postmenopausal women. High hostility scores were linked to a doubled risk of myocardial infarction, independent of other risk factors.
Area of Science:
- Cardiology
- Psychosocial Health
- Epidemiology
Background:
- Psychosocial factors are increasingly recognized for their association with coronary heart disease (CHD) risk.
- The predictive role of hostility in recurrent coronary events remains underexplored, particularly in postmenopausal women.
Purpose of the Study:
- To prospectively evaluate hostility as a risk factor for secondary CHD events in postmenopausal women.
- To determine if hostility independently predicts nonfatal myocardial infarction and CHD death.
Main Methods:
- Prospective evaluation of 792 women from the Heart and Estrogen/progestin Replacement Study (HERS).
- Assessment of hostility using Cook-Medley scores and correlation with various health and demographic factors.
- Follow-up for an average of 4.1 years to track recurrent CHD events.
Main Results:
- High hostility scores correlated with higher body mass index and triglycerides, and lower HDL cholesterol.
- Hostility was inversely associated with self-rated general health, age, and education.
- Women in the highest hostility quartile had double the risk of myocardial infarction (RH=2.03) compared to the lowest quartile.
- The association between hostility and CHD events was independent of studied biologic, behavioral, and social risk factors.
Conclusions:
- Hostility is an independent risk factor for recurrent coronary heart disease events in postmenopausal women.
- These findings highlight the importance of considering psychosocial factors in cardiovascular risk assessment and management.
Abstract:
Psychosocial characteristics may be associated with an increased risk of coronary heart disease (CHD). Whether hostility predicts recurrent coronary events is unknown. A total of 792 women in the Heart and Estrogen/progestin Replacement Study (HERS) were evaluated prospectively to determine the role of hostility as a risk factor for secondary CHD events (nonfatal myocardial infarction and CHD death). The mean age of study participants was 67 years, and the average length of follow-up was 4.1 years. The study was conducted between 1993 and 1998, and all study sites were in the United States. High Cook-Medley hostility scores were associated with greater body mass index (p = 0.01) and higher levels of serum triglycerides (p = 0.05), and they were inversely associated with high density lipoprotein cholesterol (p = 0.04), self-rated general health (p < 0.001), age (p = 0.05), and education (p = 0.001). Compared with women in the lowest hostility score quartile, women in the highest quartile were twice as likely to have had a myocardial infarction (relative hazard = 2.03, 95% confidence interval: 1.02, 4.01). The relation between hostility and CHD events was not mediated or confounded by the biologic, behavioral, and social risk factors studied. In this study, hostility was found to be an independent risk factor for recurrent CHD events in postmenopausal women.