School of Medicine, University of California, Irvine, CA.
J Am Heart Assoc. 2013 Sep 30;2(5):e000052. doi: 10.1161/JAHA.113.000052.
Hostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease (CHD), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes.
We prospectively examined the association between self-reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8-item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow-up time of 7.4 ± 2.7 years, the age-adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age-adjusted hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.30 to 2.17; P < 0.0001). After adjustment for cardiovascular risk factors, participants with hostility scores in the highest quartile had a 58% greater risk of secondary events than those in the lowest quartile (HR: 1.58, 95% CI: 1.19 to 2.09; P = 0.001). This association was mildly attenuated after adjustment for C-reactive protein (HR: 1.41, 95% CI, 1.06 to 1.87; P = 0.02) and no longer significant after further adjustment for smoking and physical inactivity (HR: 1.25, 95% CI: 0.94 to 1.67; P = 0.13).
Hostility was a significant predictor of secondary events in this sample of outpatients with baseline stable CHD. Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.
敌意是冠心病（CHD）患者死亡率和心血管事件的重要预测因素，但解释这种关联的机制尚不清楚。本研究旨在评估敌意与不良心血管结局之间关联的潜在机制。
我们前瞻性地研究了来自心脏与灵魂研究（Heart and Soul Study）的 1022 例稳定型 CHD 门诊患者中自我报告的敌意与二级事件（心肌梗死、心力衰竭、中风、短暂性脑缺血发作和死亡）之间的关联。使用 8 项 Cynical Distrust 量表评估基线敌意。使用 Cox 比例风险模型确定候选生物和行为中介因素在多大程度上改变了敌意与二级事件之间关联的强度。在平均 7.4±2.7 年的随访期间，最高四分位数组的敌意受试者的二级事件年发生率为 9.5%，最低四分位数组的发生率为 5.7%（年龄调整后的危险比[HR]：1.68，95%置信区间[CI]：1.30 至 2.17；P<0.0001）。在校正心血管危险因素后，敌意评分最高四分位数组的患者发生二级事件的风险比最低四分位数组高 58%（HR：1.58，95%CI：1.19 至 2.09；P=0.001）。在调整 C 反应蛋白（HR：1.41，95%CI：1.06 至 1.87；P=0.02）后，该关联略有减弱，在进一步调整吸烟和身体活动不足后不再显著（HR：1.25，95%CI：0.94 至 1.67；P=0.13）。
在本基线稳定型 CHD 门诊患者样本中，敌意是二级事件的重要预测因素。这种关联在很大程度上受到健康行为的调节，特别是身体活动不足和吸烟。
