title: Association between anger and mental stress-induced myocardial ischemia.
abstract: BACKGROUND
  Mental stress-induced myocardial ischemia is associated with adverse prognosis in coronary artery disease patients. Anger is thought to be a trigger of acute coronary syndromes and is associated with increased cardiovascular risk; however, little direct evidence exists for a link between anger and myocardial ischemia.
  
  
  METHODS
  [(99m)Tc]-sestamibi single-photon emission tomography was performed at rest, after mental stress (a social stressor with a speech task) and after exercise/pharmacologic stress. Summed scores of perfusion abnormalities were obtained by observer-independent software. A summed-difference score, the difference between stress and rest scores, was used to quantify myocardial ischemia under both stress conditions. The Spielberger's State-Trait Anger Expression Inventory was used to assess different anger dimensions.
  
  
  RESULTS
  The mean age was 50 years, 50% were female, and 60% were non-white. After adjusting for demographic factors, smoking, coronary artery disease severity, depressive, and anxiety symptoms, each IQR increment in state-anger score was associated with 0.36 U-adjusted increase in ischemia as measured by the summed-difference score (95% CI 0.14-0.59); the corresponding association for trait anger was 0.95 (95% CI 0.21-1.69). Anger expression scales were not associated with ischemia. None of the anger dimensions was related to ischemia during exercise/pharmacologic stress.
  
  
  CONCLUSIONS
  Anger, both as an emotional state and as a personality trait, is significantly associated with propensity to develop myocardial ischemia during mental stress but not during exercise/pharmacologic stress. Patients with this psychologic profile may be at increased risk for silent ischemia induced by emotional stress, and this may translate into worse prognosis.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Pratik
authors.initials: P
authors.lastname: Pimple
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Cherie
authors.initials: C
authors.lastname: Rooks
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Bremner
authors.affiliation: Department of Radiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Nye
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Ibeanu
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Murrah
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Shallenberger
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Mary
authors.initials: M
authors.lastname: Kelley
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, Edmonton, Alberta, Canada.
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. Electronic address: viola.vaccarino@emory.edu.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
mesh_terms: D000328:Adult; D000786:Anger; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000523:psychology*; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D013315:Stress, Psychological / Q000150:complications*