title: Tendency to angry rumination predicts stress-provoked endothelin-1 increase in patients with coronary artery disease.
abstract: OBJECTIVE
  To determine whether a tendency to angry rumination predicts anger recall (AR) stress-provoked increase in endothelin (ET)-1 among patients with coronary heart disease (CHD).
  
  
  METHODS
  Patients with chronic stable CHD (n = 105) completed a five-item measure of tendency to angry rumination (DAB-VR) and underwent a laboratory AR stress protocol (15-minute resting baseline [BL], 8-minute AR). Blood samples drawn at end of BL and AR were assayed for ET-1. Change in ET-1 from BL to AR (increase versus decrease/no change) was treated dichotomously in multivariate logistic regression models, including DAB-VR score and potential confounders, to evaluate the contribution of DAB-VR to the prediction of change in ET-1.
  
  
  RESULTS
  In the multivariate model, DAB-VR score significantly predicted ET-1 increase (odds ratio, 1.34; 95% confidence interval, 1.10-1.1.63; p = .004), controlling for age, history of diabetes, hypercholesterolemia, rate pressure product, use of beta blockers, and statins.
  
  
  CONCLUSIONS
  A tendency to angry rumination independently predicted AR stress-provoked ET-1 increase among patients with CHD. Given the involvement of ET-1 in plaque rupture, anger rumination tendency may identify vulnerability to anger-triggered acute coronary syndrome through prolongation of initial anger mobilization. The contribution of ruminative thinking to sustained poststress ET-1 elevation and the synergistic relationship of ET-1 during emotional stress with norepinephrine and nitric oxide remain to be explored.
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Antonio B
authors.initials: AB
authors.lastname: Fernandez
authors.forename: Robert
authors.initials: R
authors.lastname: Soufer
authors.forename: Dorothea
authors.initials: D
authors.lastname: Collins
authors.forename: Aaron
authors.initials: A
authors.lastname: Soufer
authors.forename: Hooman
authors.initials: H
authors.lastname: Ranjbaran
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
mesh_terms: D000368:Aged; D000786:Anger / Q000502:physiology*; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis; D003625:Data Collection / Q000706:statistics & numerical data; D004562:Electrocardiography; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000502:physiology*; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000097:blood*; D013850:Thinking / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis
chemical_list: D019332:Endothelin-1; D009638:Norepinephrine