title: Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: the Women's Ischemia Syndrome Evaluation (WISE) Study.
abstract: OBJECTIVE
  To determine the relationship of anger and hostility to angiographic coronary artery disease (CAD), symptoms, and functional status among women with suspected CAD.
  
  
  METHODS
  Data were collected from 636 women with suspected CAD referred for diagnostic angiography in the Women's Ischemia Syndrome Evaluation (WISE) Study. CAD was assessed as angiographic presence/absence of disease (> or =50% stenosis in any epicardial coronary artery). Hostility/anger, angina, symptoms, and functional status were assessed by the Cook-Medley Hostility Inventory, Spielberger Anger Expression Scale, cardiovascular symptom history, and the Duke Activity Status Index.
  
  
  RESULTS
  Logistic regression revealed that anger-out (i.e., aggressive behavior in response to angry feelings) was independently associated with the presence/absence of angiographic CAD (OR = 1.09, CI 1.01-1.17). Anger and hostility were higher among women reporting increased cardiovascular symptoms. In women without angiographic CAD, those with nonanginal cardiac symptoms had the highest anger-out, anger expression, hostile affect, and aggressive responding scores, and those with typical angina reported the lowest functional status. Among women with CAD, functional status was lowest in women with atypical angina.
  
  
  CONCLUSIONS
  Among women with suspected CAD, anger-out scores were associated with the presence of angiographic CAD. Anger/hostility traits were associated with increased symptoms, particularly with nonanginal chest pain in women without angiographic CAD. Relationships among psychosocial factors, cardiac symptoms, and angiographic CAD are potentially important in the management of women with suspected CAD.
authors.affiliation: Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences, Bethesda, Maryland 20814, USA. dskrantz@usuhs.mil
authors.forename: David S
authors.initials: DS
authors.lastname: Krantz
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Francis
authors.forename: Carolyn
authors.initials: C
authors.lastname: Phankao
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Diane A
authors.initials: DA
authors.lastname: Vido
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D000368:Aged; D000786:Anger; D000787:Angina Pectoris / Q000150:complications / Q000175:diagnosis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006304:Health Status; D006791:Hostility; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016387:Women's Health