Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, 622 W. 168th St., New York, NY 10032, USA.
Am Heart J. 2010 Feb;159(2):199-206. doi: 10.1016/j.ahj.2009.11.007.
Whereas some studies have found that anger increases the risk of incident coronary heart disease (CHD), others found anger to be protective. Prior studies did not account for different types of anger expression, which may be associated with opposing levels of cardiovascular risk. This study examines whether distinct types of anger expression differentially predict incident CHD.
We conducted a population-based, observational prospective study of 785 randomly selected Canadian men and women (50% each) aged 46 to 92 years and free of CHD in 1995. Using videotaped interviews, trained coders rated 3 types of anger expression: constructive anger (discussing anger to resolve the situation), destructive anger justification (blaming others for one's anger), and destructive anger rumination (brooding over an anger-inducing incident). The association between anger expression type per SD and incident CHD was estimated using Cox proportional hazards models adjusted for sex, age, cardiovascular risk factors, depressive symptoms, hostility, and anxiety. Interactions of anger expression type and gender were also tested.
There were 115 incident CHD events (14.6%) during 6,584 person-years of follow-up. The association between clinically assessed constructive anger expression and CHD varied by gender (P for interaction = .02); higher levels were associated with a lower risk of incident CHD in men only (hazard ratio 0.58, 95% CI 0.43-0.80, P < .001), whereas higher levels of destructive anger justification was associated with a 31% increased risk of CHD in both sexes (hazard ratio 1.31, 95% CI 1.03-1.67, P = .03) and predicted CHD incidence independent of covariates and depressive symptoms, hostility, and anxiety.
Decreased constructive anger in men and increased destructive anger justification in men and women are associated with increased risk of 10-year incident CHD.
虽然一些研究发现愤怒会增加冠心病（CHD）的发病风险，但也有研究发现愤怒具有保护作用。既往研究并未考虑不同类型的愤怒表达，这可能与心血管风险水平的变化有关。本研究旨在探讨不同类型的愤怒表达是否会对冠心病发病产生差异预测。
我们进行了一项基于人群的前瞻性观察研究，纳入了 1995 年时无冠心病的 785 名随机选择的加拿大男性和女性（各占 50%），年龄 46 至 92 岁。通过录像访谈，经过培训的编码员对 3 种愤怒表达类型进行了评分：建设性愤怒（讨论愤怒以解决问题）、破坏性愤怒合理化（将自己的愤怒归咎于他人）和破坏性愤怒沉思（对引发愤怒的事件进行沉思）。使用 Cox 比例风险模型，根据性别、年龄、心血管危险因素、抑郁症状、敌意和焦虑对每标准差的愤怒表达类型与冠心病发病之间的关联进行了调整。还测试了愤怒表达类型与性别之间的交互作用。
在 6584 人年的随访期间，共发生 115 例冠心病事件（14.6%）。临床评估的建设性愤怒表达与冠心病之间的关联因性别而异（交互作用 P 值=.02）；仅在男性中，更高水平的建设性愤怒表达与冠心病发病风险降低相关（风险比 0.58，95%CI 0.43-0.80，P <.001），而男性和女性中更高水平的破坏性愤怒合理化与冠心病发病风险增加 31%相关（风险比 1.31，95%CI 1.03-1.67，P =.03），并且独立于协变量、抑郁症状、敌意和焦虑预测冠心病发病。
男性中建设性愤怒的减少和男性及女性中破坏性愤怒合理化的增加与 10 年冠心病发病风险增加有关。
