Abstract 1172: CAD Patients Who Suppress Their Anger Are at Increased Risk of Major Cardiac Events
Introduction. Recent evidence suggests that anger may be associated with the progression of CAD but little is known about the cardiovascular effects of suppressing anger.
Hypothesis. We assessed the hypothesis that patients with CAD who suppress their anger are at increased risk for major clinical events, and that suppression of anger is a stable trait.
Methods. At baseline, 644 CAD patients completed measures of anger, suppressed anger and Type D personality (tendency to inhibit the expression of negative emotions). The endpoint was cardiac death or non-fatal MI after an average follow-up of 6.3 years.
Results. At follow-up, 59 patients had died of cardiac causes or suffered an MI. Patients who suppressed their anger had an increased risk of cardiac death/MI as compared with other patients; i.e., 12/51=24% versus 47/593=8% (p<0.0001). Left ventricular ejection fraction ≤50%, poor exercise tolerance, and conservative medical treatment were associated with poor prognosis. After controlling for these cardiac risk factors, age and gender, suppressed anger still predicted a more than 2-fold increased risk of cardiac death/MI. In a multivariate regression model, suppressed anger (OR=2.87, 95%CI 1.15–7.15, p=0.024), LVEF≤50% (p=0.008), poor exercise tolerance (p=0.001), 3-vessel disease 1(p=0.042), and no invasive treatment at baseline (p<0.022) were retained as independent predictors. Suppressed anger was present in 18% of patients with a Type D personality (31/174) and in 4% of non-Type D patients (20/470), p<0.0001. Entering Type D personality and suppressed anger at the same time in a regression model indicated that Type D (OR=3.40, 95%CI 1.88 – 6.14) accounted for the association between suppressed anger and cardiac events.
Conclusions. CAD patients who suppress their anger are at risk for cardiac death or MI, even after adjusting for disease severity. Suppressed anger is significantly more present among patients with a Type D personality profile, which accounts for its prognostic value.