title: Hostility, anger control, and anger expression as predictors of cardiovascular disease.
abstract: OBJECTIVE
  To examine in a prospective setting whether different hostility measures, including Cynical Distrust, Trait Anger, Anger Out, Anger In, and Anger Control, are related to cardiovascular disease (CVD) and ischemic heart disease (IHD).
  
  
  METHODS
  Participants comprised 25- to 74-year-old men (n = 3850) and women (n = 4083), followed up for 10 to 15 years. Trait Anger, Anger Out, Anger In, and Anger Control were assessed with the Spielberger State-Trait Anger Expression Inventory and Cynical Hostility with the Cynical Distrust Scale. Incident CVD and IHD were derived from hospital records/death certificates. Subjects with a history of CVD or IHD at baseline were excluded.
  
  
  RESULTS
  Subjects in the lowest Anger Control tertile had a higher risk of first nonfatal and fatal CVD incidence (relative risk [RR], 1.35; 95% confidence interval [CI], 1.06-1.73) than subjects in the highest tertile after adjustment for age, gender, education, marital status, smoking, body mass index, blood pressure, cholesterol, alcohol consumption, and depressive symptoms. Higher Cynical Distrust scores predicted nonfatal and fatal CVD (RR, 1.31; 95% CI, 1.09-1.56) and IHD (RR, 1.37; 95% CI, 1.08-1.74) events after adjustment for age, but these associations disappeared after further adjustment for gender, education, and marital status. Other hostility measures, i.e., Trait Anger, Anger Out, or Anger In, were not related to CVD or IHD outcomes.
  
  
  CONCLUSIONS
  This is the first study to show that compared with four other hostility dimensions, low Anger Control predicts CVD events. Further studies should examine whether Anger Control is specific to anger or reflects more general psychosocial factors.
authors.affiliation: Department of Social Psychology, University of Helsinki, FI-00014 Helsinki, Finland. ari.haukkala@helsinki.fi
authors.forename: Ari
authors.initials: A
authors.lastname: Haukkala
authors.forename: Hanna
authors.initials: H
authors.lastname: Konttinen
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Antti
authors.initials: A
authors.lastname: Uutela
mesh_terms: D000339:Affect; D000786:Anger / Q000145:classification*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006791:Hostility; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D011336:Probability; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012306:Risk; D012307:Risk Factors; D014434:Type A Personality