Abstract P083: Poor Health Behaviors Explain Increased Risk of Cardiovascular Events in Hostile Patients with Coronary Heart Disease: Findings from the Heart and Soul Study
Background: Hostility is a significant predictor of adverse cardiovascular (CV) events in patients with coronary heart disease (CHD) but the mechanisms that explain this association are unknown. Hypothesis: We assessed the hypothesis that controlling for poor health behaviors (physical inactivity, medication nonadherence, and smoking) would eliminate the association between hostility and future CV events.
Methods: We prospectively examined the association between self-reported hostility and CV events in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8-item Cynical Distrust Scale. Log hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and CV events (myocardial infarction, heart failure, stroke, transient ischemic attack, or death).
Results: A total of 592 CV events occurred during 8 years of follow-up. Each standard-deviation increase in hostility score was associated with a 20% increased risk of CV events (age-adjusted hazard ratio [HR] 1.20; 95% CI, 1.09-1.31; P=0.0001). The age-adjusted annual rate of CV events was 10.4% among the 185 subjects in the highest quartile of hostility and 6.2% among the 333 subject in the lowest quartile of hostility (HR 1.67; 95% CI, 1.27-2.18; P=0.0002). After adjustment for comorbid diseases and cardiac disease severity, participants with hostility scores in the highest quartile had a 46% higher rate of CV events than those with scores in the lowest quartile (HR 1.46; 95% CI, 1.09-1.98; P=0.01). This association was no longer statistically significant after adjustment for smoking, medication non-adherence and physical inactivity (HR 1.12; 95% CI, 0.87-1.63; P=0.27).
Conclusions: Hostility was a significant predictor of adverse CV events in this sample of patients with stable CHD, but the association was eliminated after adjustment for poor health behaviors.
|Model Adjusted for†||HR (95% CI)||P value|
|Above + Male, White||1.70 (1.29-2.24)||0.0002|
|Above + depressive symptoms||1.56 (1.17-2.08)||0.003|
|Above + MI, diabetes, LVEF||1.46 (1.09-1.98)||0.01|
|Above + CRP||1.36 (1.00-1.84)||0.05|
|Above + smoking||1.31 (0.97-1.78)||0.08|
|Above + medication nonadherence||1.26 (0.92-1.72)||0.14|
|Above + physical inactivity||1.19 (0.87-1.63)||0.27|
- © 2012 by American Heart Association, Inc.