Abstract P156: Anger Expression and Incident Diabetes Among African American Adults: The Jackson Heart Study
Purpose: Type 2 diabetes mellitus (T2DM) is highly prevalent in African American (AA) adults. Negative emotional states, such as anger, have been linked to cardiovascular disease (CVD) and CVD risk factors. However, previous studies involving glucose metabolism are conflicting and analyses exploring the relationship between anger expression and incident T2DM are limited, especially in AAs. We hypothesize that high levels of anger expression will be associated with increased incident T2DM in AAs.
Methods: A cohort study was conducted on 5301 AAs recruited during 2000-2004, from 3 counties in Jackson, MS. All participants who completed the Spielberger Anger Expression scale at the baseline visit without diagnosed T2DM were eligible for inclusion in this analysis. This scale is a 16-item tool that measures internalization of anger or anger-in (8 items) and external expression of anger or anger-out (8 items) among participants, with higher scores signifying higher frequency of self-perceived expression of anger-in and/or anger-out behaviors. The primary outcome was diagnosis of T2DM between 2005 and 2010. Subjects with Anger expression scores in the highest quartile (score >=15 /32 for anger-in and >=14/32 for anger-out) were compared to the remaining participants. We related anger-in scores with incident T2DM using Cox proportional hazards modeling and adjusted for potential confounding (age, smoking status, education level, and baseline levels of A1c and body mass index). Since anger expression may vary by sex, a stratified analysis by sex was conducted. Analyses were repeated for anger-out as the main exposure.
Results: A total of 2483 participants completed the anger-in scale and 2525 participants completed the anger-out scale. The cohort was 64.5% female with a mean age of 52.6 ± 12.6 years. After 7.0 ± 1.9 years of follow-up, incident T2DM was highest amongst men with an anger-in score in the highest quartile at 26.9%, followed by the remaining men at 21.8%, followed by the remaining women at 20.7% and then by women with the highest quartile of anger-in score (19.5%), p = 0.21 amongst 4 groups. Cox modeling showed an increase in hazards of incident T2DM among men with an anger-in score in the highest quartile compared to the remaining men, adjusted Hazards Ratio 1.54, 95% CI 1.08 - 2.20 (p=0.017). A similar relationship was not found in women (Hazards Ratio 0.77, 95% CI 0.57-1.06, p=0.107). There was no significant relationship between anger-out scores and incident T2DM.
Conclusions: African American men, but not women, with high internalization of anger (anger-in) were found to have an increased incidence of T2DM over a 10-year follow-up period. External expression of anger (anger-out) was not related to incident T2DM. Further studies exploring the underlying pathways of this relationship and risk reduction strategies may be warranted.
Author Disclosures: T.H. Taveira: None. M.L. Hershey: None. K. Knoph: None. D. Hickson: None. W. Wu: None.
- © 2015 by American Heart Association, Inc.