Cynical hostility, anger expression style, and acute myocardial infarction in middle-aged Japanese men

Studies using American and European populations have demonstrated that high levels of anger/ hostility are predictive of coronary heart disease (CHD) mortality. However, Japanese studies did not show consistent relationship between anger/hostility and CHD. This study examines the association of cynical hostility and anger expression style with acute myocardial infarction (AMI) in middle-aged Japanese men through a case-control study. The patients with acute myocardial infarction (N = 96, mean age = 50.8 years) and the healthy participants in a health check-up program (N = 77, mean age = 50.3 years) were studied. Both groups completed the Cynicism Questionnaire (CQ) and the State-Trait Anger Expression Inventory (STAXI). The patients exhibited higher scores on CQ than the healthy controls. Logistic regression analyses controlling for biological risk factors revealed that the CQ score was associated with increased risk of AMI (OR = 1.11 [95% CI 1.00-1.22]). In addition, the score of Anger-control, a subscale of STAXI, was associated with decreased risk of AMI (OR = 0.75 [95% CI 0.62-0.92]). These results indicated that higher levels of cynical hostility increased the risk of AMI and that anger-control strategies could have some benefit in reducing the risk of AMI in middle-aged Japanese men.