Hostility Scores Are Associated With Increased Risk of Cardiovascular Events in Women Undergoing Coronary Angiography: A Report from the NHLBI-Sponsored WISE Study

Abstract

Objective: 

To evaluate hostility-related personality traits assessed by the Cook Medley Hostility Inventory and to relate these to the occurrence of adverse cardiac events in women with suspected myocardial ischemia.

Methods: 

The cohort included 506 women with suspected coronary artery disease from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. We examined individual components of the Cook Medley Hostility Score (CMHS) measuring cynicism, hostile affect, and aggressive responding, and a total CMHS (sum of these three) and associations with adverse events (defined as hospitalization for angina, nonfatal myocardial infarction, stroke, congestive heart failure (CHF) other vascular events and death) during 3 to 6 years follow-up using Cox proportional hazard modeling.

Results: 

Women with adverse events had higher total CMHS (10.6 ± 5.5) than women without any of these events (9.2 ± 5.1) p = .02. They also had poorer survival by Kaplan-Meier analysis (log-rank p < .05). Unadjusted Cox models showed that the individual scores of cynicism and aggressive responding and the total CMHS were associated with more adverse events (all p < .05). Women with total CMHS above the median had a 35% increase risk of an adverse event in comparison to women with lower scores. In a risk-adjusted Cox model, the hazard ratio for an adverse event was 1.5 (p = .03) for women with total CMHS above the median.

Conclusion: 

In this cohort of women with suspected myocardial ischemia, higher Cook Medley scores reflecting cynicism, hostile affect, and aggressive responding were associated with poorer 3 to 6 year event-free survival and a higher risk of adverse events. After adjusting for risk factors and CAD, the association with risk for adverse events increased.

CAD = coronary artery disease;

CHF = congestive heart failure,

HT = hormone therapy;

WISE = Women’s Ischemia Syndrome Evaluation;

CHD = coronary heart disease;

MI = myocardial infarction;

HERS = Heart and Estrogen/Progestin Replacement Study;

NHLBI = National Heart, Lung, and Blood Institute;

CMHS = Cook Medley Hostility Score.