title: Anger proneness, gender, and the risk of heart failure.
abstract: BACKGROUND
  Evidence regarding the association of anger proneness with incidence of heart failure is lacking.
  
  
  RESULTS
  Anger proneness was ascertained among 13,171 black and white participants of the Atherosclerosis Risk in Communities (ARIC) study cohort with the use of the Spielberger Trait Anger Scale. Incident heart failure events, defined as occurrence of ICD-9-CM code 428.x, were ascertained from participants' medical records during follow-up in the years 1990-2010. Relative hazard of heart failure across categories of trait anger was estimated with the use of Cox proportional hazard models. Study participants (mean age 56.9 [SD 5.7] years) experienced 1,985 incident HF events during 18.5 (SD 4.9) years of follow-up. Incidence of HF was greater among those with high, as compared to those with low or moderate trait anger, with higher incidence observed for men than for women. The relative hazard of incident HF was modestly high among those with high trait anger, compared with those with low or moderate trait anger (age-adjusted hazard ratio for men: 1.44 (95% confidence interval [CI] 1.23-1.69). Adjustment for comorbidities and depressive symptoms attenuated the estimated age-adjusted relative hazard in men to 1.26 (95% CI 1.00-1.60).
  
  
  CONCLUSIONS
  Assessment of anger proneness may be necessary in successful prevention and clinical management of heart failure, especially in men.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina. Electronic address: anna_newton@unc.edu.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kucharska-Newton
authors.affiliation: Department of Epidemiology and Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia.
authors.forename: Janice E
authors.initials: JE
authors.lastname: Williams
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Sueta
authors.affiliation: Departments of Population Health and Medicine, New York University, New York, New York.
authors.forename: Saul B
authors.initials: SB
authors.lastname: Blecker
authors.affiliation: Department of Medicine, University of Mississippi, Jackson, Mississippi.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000786:Anger / Q000502:physiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D044465:White People / Q000706:statistics & numerical data
keywords: Trait anger; cohort; hospitalization; incidence