title: Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients.
abstract: Acute high levels of anger and anxiety are associated with an elevated risk of myocardial infarction (MI) in the following two hours. MIs preceded by these acute negative emotions may also have a poor long-term prognosis, but information about high-risk patients is lacking. We examined whether young age and female sex are associated with MIs that are preceded by negative emotions and whether age and sex moderate the subsequent increased mortality risk following MI preceded by negative emotions.
  
  
  
  We conducted a secondary analysis of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age=60.1±12.3years, 29.2% women). Anxiety and anger immediately prior to (0-2h) MI and the day before (24-26h) MI were assessed using a structured interview. Subsequent 10-year all-cause mortality was determined using the US National Death Index.
  
  
  
  Anxiety during the 0-2h pre-MI period was associated with younger age (OR=0.98,95% CI=0.96-0.99 per year) and female sex (OR=1.50,95% CI=1.11-2.02). Anger in the 0-2h pre-MI period was also associated with younger age (OR=0.95,95% CI=0.94-0.96) but not with sex (OR=0.93,95% CI=0.67-1.28). During follow-up, 580 (26.7%) patients died. Mortality rate was higher if MI occurred immediately after high anxiety, particularly in patients ≥65years (HR=1.80,95% CI=1.28-2.54) vs. younger patients (HR=0.87,95% CI=0.55-1.40; p-interaction=0.015). Other interactions with sex or anger were not significant.
  
  
  
  Patients with high anxiety or anger levels in the critical 2-hour period prior to MI are younger than those without such emotional precipitants. In addition, pre-MI anxiety is associated with an elevated 10-year mortality risk in patients aged ≥65years.
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, The Netherlands.
authors.forename: Loes
authors.initials: L
authors.lastname: Smeijers
authors.affiliation: Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mostofsky
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Tofler
authors.affiliation: InfraReDx, Burlington, MA, United States.
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, The Netherlands. Electronic address: w.j.kop@tilburguniversity.edu.
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Kop
authors.affiliation: Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States. Electronic address: mmittlem@bidmc.harvard.edu.
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000367:Age Factors; D000368:Aged; D000786:Anger; D001007:Anxiety / Q000150:complications* / Q000523:psychology*; D001008:Anxiety Disorders; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000523:psychology*; D011379:Prognosis; D012306:Risk; D013223:Statistics as Topic
keywords: Acute stress; Anger; Anxiety; Mortality; Myocardial infarction; Risk factors