Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA.
J Am Coll Cardiol. 2011 Sep 13;58(12):1222-8. doi: 10.1016/j.jacc.2011.04.044.
The aim of this study was to examine the relation between hostility and incident ischemic heart disease (IHD) and to determine whether observed hostility is superior to patient-reported hostility for the prediction of IHD in a large, prospective observational study.
Some studies have found that hostile patients have an increased risk of incident IHD. However, no studies have compared methods of hostility assessment or considered important psychosocial and cardiovascular risk factors as confounders. Furthermore, it is unknown whether all expressions of hostility carry equal risk or whether certain manifestations are more cardiotoxic.
We assessed the independent relationship between baseline observed hostility and 10-year incident IHD in 1,749 adults of the population-based Canadian Nova Scotia Health Survey.
There were 149 (8.5%) incident IHD events (140 nonfatal, 9 fatal) during the 15,295 person-years of observation (9.74 events/1,000 person-years). Participants with any observed hostility had a greater risk of incident IHD than those without (p = 0.02); no such relation was found for patient-reported hostility. Those with any observed hostility had a significantly greater risk of incident IHD (hazard ratio: 2.06, 95% confidence interval: 1.04 to 4.08, p = 0.04), after adjusting for cardiovascular (age, sex, Framingham Risk Score) and psychosocial (depression, positive affect, patient-reported hostility, and anger) risk factors.
The presence of any observed hostility at baseline was associated with a 2-fold increased risk of incident IHD over 10 years of follow-up. Compared with patient-reported measures, observed hostility is a superior predictor of IHD.
本研究旨在探讨敌意与缺血性心脏病（IHD）事件之间的关系，并确定在一项大型前瞻性观察研究中，观察到的敌意是否优于患者报告的敌意，从而预测 IHD。
一些研究发现，敌意患者发生 IHD 的风险增加。然而，尚无研究比较敌意评估方法，或考虑重要的心理社会和心血管风险因素作为混杂因素。此外，尚不清楚所有敌意表达是否具有同等风险，或者某些表现是否更具心脏毒性。
我们评估了基线观察到的敌意与人群为基础的加拿大新斯科舍省健康调查 1749 名成年人 10 年 IHD 事件发生率之间的独立关系。
在 15295 人年的观察期间（9.74 例/1000 人年），发生了 149 例（8.5%）IHD 事件（140 例非致命性，9 例致命性）。与无任何观察到的敌意的参与者相比，有任何观察到的敌意的参与者发生 IHD 事件的风险更高（p=0.02）；但患者报告的敌意与 IHD 事件之间没有这种关系。在调整心血管（年龄、性别、弗雷明汉风险评分）和心理社会（抑郁、积极情绪、患者报告的敌意和愤怒）风险因素后，任何观察到的敌意与 IHD 事件的发生风险显著相关（危险比：2.06，95%置信区间：1.04 至 4.08，p=0.04）。
基线时存在任何观察到的敌意与 10 年随访期间发生 IHD 的风险增加 2 倍相关。与患者报告的测量相比，观察到的敌意是 IHD 的更好预测指标。
