Abstract 14888: State-Trait Anger is Significantly Associated With Mental Stress Induced Myocardial Ischemia
Objective: Mental stress-induced myocardial ischemia (MSMI) is associated with worse prognosis in CAD patients and is a marker of the effects of psychological stress on cardiac function. Acute anger has been implicated as a trigger of acute coronary syndromes, and anger as an emotional state or a personality trait has been associated with adverse coronary events. We examined whether various anger dimensions are associated with MSMI in CAD patients.
Methods: We used single-photon emission tomography (SPECT) at rest and in conjunction with standardized psychological stress (mental stress testing via speech task), in addition to conventional physical (exercise or pharmacological) stress test in 98 subjects with a history of MI in the previous 6 months. Summed scores of perfusion defects were obtained with mental stress, physical stress, and at rest, using a reader-independent, software-based method. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under mental stress (MSDS) and physical stress (PSDS). The Spielberger’s State-Trait Anger Expression Inventory was used to assess anger dimensions including state anger, trait anger, anger expression-in, anger expression-out, and anger control. Linear regression models were used to model the association between ischemia scores (MSDS & PSDS) as dependent variables with anger subscales and adjusting for potential confounding factors.
Results: Forty-nine subjects were ≤ 50 years of age, 49 were female and 59 were non-white. After adjusting for demographic factors, smoking, CAD severity and depressive symptoms, each 1-point increase in the anger state score was associated with 0.12 units increase in MSDS (95% CI: 0.05 - 0.20, p=0.001); the corresponding association for anger trait was 0.16 (95% CI: 0.04 - 0.28, p=0.01). Scores for anger expression and anger control were not associated with MSDS. None of the anger subscales were related to PSDS.
Conclusion: Anger both as an emotional state and as a stable personality trait is significantly associated with propensity to develop MSMI, but not physical stress-induced MI. Patients with this psychological profile may be at increased risk of ischemia induced by emotional stress.
- © 2013 by American Heart Association, Inc.