title: Hostility and acute coronary syndrome in a transitional post-communist Muslim country: a population-based study in Tirana, Albania.
abstract: BACKGROUND
  The study aims to assess: (i) the association of hostility with socio-demographic, psychosocial and coronary risk factors and (ii) the association of hostility with acute coronary syndrome (ACS) in post-communist secular though predominantly Muslim Albania.
  
  
  METHODS
  In a population-based case-control study conducted in Tirana in 2003-06, 464 non-fatal sequential ACS patients (368 men, 96 women, 87% response) and a population-sampled control group (n = 684; 449 men, 235 women, 65.5% response) provided data on Cynical Distrust, a measure of hostility. The correlates of hostility in the population sample were assessed using the general linear model and the association of hostility with ACS in the case-control comparison by multivariable-adjusted logistic regression.
  
  
  RESULTS
  In the population-based sample, hostility was related to age (inversely in men), social position, social mobility, relative income (all inverse in both sexes) and emigration of close family. In the case-control comparison, there was a strong graded relationship of hostility with ACS, independent of socio-demographic characteristics and conventional coronary risk factors, including lifestyle/behavioural factors [odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.18-1.34 in men, and OR = 1.17, 95% CI = 1.05-1.32 in women per unit score of hostility and OR = 5.3, 95% CI = 3.3-8.6 in men and OR = 3.1, 95% CI = 1.1-8.6 in women for upper versus lower tertiles].
  
  
  CONCLUSIONS
  This may be the first report from post-communist countries of Eastern and Southeastern Europe or from a Muslim population on the hostility trait in a population-representative sample. Hostility was independently associated with ACS. This requires confirmation, in particular, to exclude the possibility of reverse causality. Hostility may represent an informative risk factor in transitional populations.
authors.affiliation: Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. Genc.Burazeri@INTHEALTH.unimaas.nl
authors.forename: Genc
authors.initials: G
authors.lastname: Burazeri
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000415:Albania / Q000453:epidemiology; D016022:Case-Control Studies; D003148:Communism; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D006791:Hostility; D006801:Humans; D007514:Islam; D008297:Male; D008875:Middle Aged; D011584:Psychology; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires