Defensive hostility: relationship to multiple markers of cardiac ischemia in patients with coronary disease
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K F Helmers1, D S Krantz, C N Merz
1Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
Insights
Hostility and defensiveness combined identify individuals with severe coronary artery disease (CAD). These defensive hostile patients show worse outcomes, including greater perfusion defects and more ischemia, suggesting a poorer prognosis.
Area of Science:
- Psychosomatic Medicine
- Cardiology
- Behavioral Medicine
Background:
- Coronary Artery Disease (CAD) is a significant health concern.
- Psychological factors, including hostility, may influence CAD severity and prognosis.
- The role of combined hostility and defensiveness in CAD requires further investigation.
Purpose of the Study:
- To determine if combined hostility and defensiveness identify a subgroup of patients with functionally severe Coronary Artery Disease (CAD).
- To assess the association between this combined trait and objective measures of CAD severity.
Main Methods:
- Three studies involved CAD patients completing the Cook-Medley Hostility Inventory (Ho) and Marlowe-Crowne Social Desirability Scale (MC).
- Patients were categorized into four groups: defensive hostile (DH), low hostile (LH), high hostile (HH), and defensive (Def).
- Measures included exercise thallium scintigraphy, ambulatory electrocardiographic monitoring, and echocardiography during mental stress testing.
Main Results:
- Defensive hostile (DH) CAD patients exhibited the greatest perfusion defects compared to other groups.
- DH patients experienced the most frequent ischemic episodes during monitoring.
- Laboratory assessments revealed the most severe mental stress-induced ischemia in DH patients.
Conclusions:
- The combination of high hostility and high defensiveness is associated with more functionally severe Coronary Artery Disease (CAD).
- This specific psychological profile may predispose CAD patients to a more adverse prognosis.
- Identifying DH individuals could aid in risk stratification and personalized patient management.
Abstract:
Three studies assessed whether the combined traits of hostility and defensiveness identify a group of hostile individuals with functionally severe coronary artery disease (CAD). CAD patients completed the Cook-Medley Hostility Inventory (Ho) and the Marlowe-Crowne Social Desirability Scale (MC). Patients were classified into 4 groups: defensive hostile (DH: high Ho, high MC), low hostile (LH: low Ho, low MC), high hostile (HH: high Ho, low MC), and defensive (Def: low Ho, high MC). DH in comparison to HH, LH, and Def CAD patients demonstrate the greatest perfusion defects as measured by exercise thallium scintigraphy; DH patients exhibit the most frequent ischemic episodes during ambulatory electrocardiographic monitoring; and in a laboratory study, DH patients exhibit the most severe mental stress-induced ischemia assessed by echocardiography. Thus, the combination of high hostility and high defensiveness are associated with more functionally severe CAD and may predispose CAD patients to a more adverse prognosis.