Anger, Suppressed Anger, and Risk of Adverse Events in Patients With Coronary Artery Disease
Anger, Suppressed Anger, and Risk of Adverse Events in Patients With Coronary Artery Disease
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DOI：
10.1016/j.amjcard.2010.01.015
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发表时间：
2010-06-01
影响因子：
2.8
通讯作者：
Conraads, Viviane M.
中科院分区：
文献类型：
--
作者：
Denollet, Johan;Gidron, Yori;Conraads, Viviane M.
愤怒与心血管应激反应有关;然而，对冠心病（CAD）患者抑制愤怒的影响知之甚少。我们检查了抑制愤怒的CAD患者是否有发生不良事件的风险。在基线时，644名CAD患者完成了愤怒、愤怒（不愿表达愤怒）和D型人格（经历痛苦和被抑制的倾向）的测量。高愤怒和愤怒的分数的组合被用来确定压抑的愤怒的存在。终点为主要不良心脏事件（死亡、心肌梗死和血运重建的复合事件）和心脏性死亡/心肌梗死。平均随访6.3年（范围5 - 10年）后，126例患者（20%）发生了严重不良心脏事件，59例（9%）发生了心脏性死亡或心肌梗死。愤怒（p = 0.009）和抑制愤怒（p = 0.011）与未来主要不良心脏事件相关，但在调整临床特征后，这些相关性不再显著。然而，在控制了收缩功能下降、运动耐量差、CAD程度和血运重建后，抑制愤怒仍然与更严格的终点心源性死亡或心肌梗死相关（比值比2.87，95%置信区间1.15至7.15，p = 0.024）。单独的愤怒与该终点无关。具有D型人格的患者有四倍的抑制愤怒的比率，并且对D型人格的调整减弱了所观察到的抑制愤怒与不良心脏事件之间的关联。总而言之，患有冠心病的患者，压抑他们的愤怒情绪会增加不良心脏事件的风险，这是由D型人格的个体差异造成的。(C)2010年爱思唯尔公司All rights reserved. (Am J Cardiol 2010;105：1555-1560）
Anger is associated with cardiovascular stress reactivity; however, little is known about the effect of suppressed anger in patients with coronary artery disease (CAD). We examined whether patients with CAD who suppress their anger are at risk of adverse events. At baseline, 644 patients with CAD completed measures of anger, anger-in (reluctance to express anger), and Type D personality (tendency to experience distress and to be inhibited). The combination of high anger and anger-in scores was used to identify the presence of suppressed anger. The end points were major adverse cardiac events (a composite of death, myocardial infarction, and revascularization) and cardiac death/myocardial infarction. After an average follow-up of 6.3 years (range 5 to 10), 126 patients (20%) had experienced a major adverse cardiac event, and 59 (9%) had experienced cardiac death or myocardial infarction. Anger (p = 0.009) and suppressed anger (p = 0.011) were associated with future major adverse cardiac events, but these associations were no longer significant after adjustment for clinical characteristics. However, suppressed anger remained associated with the more rigorous end point of cardiac death or myocardial infarction (odds ratio 2.87, 95% confidence interval 1.15 to 7.15, p = 0.024) after controlling for decreased systolic function, poor exercise tolerance, extent of CAD, and revascularization. Anger alone was not independently associated with this end point. Patients with a Type D personality had a fourfold rate of suppressed anger, and an adjustment for a Type D personality attenuated the observed association between suppressed anger and adverse cardiac events. In conclusion, patients with CAD who suppress their anger were at increased risk of adverse cardiac events, and this was accounted for by individual differences in Type D personality. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1555-1560)