Hostility Preceding Second Heart Attack May Increase Risk of Death

Heart attack patients who are sarcastic or irritable could be putting their health at risk, according to research published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC). Heart attack patients who are sarcastic or irritable could be putting their health at risk. Hostility is a personality trait that includes being sarcastic, cynical, resentful, impatient or irritable.

A heart attack, also called a myocardial infarction, happens when a part of the heart muscle doesn’t get enough blood. Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.

The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle. Chest pain or discomfort, feeling weak, light-headed, or faint may indicate a heart attack. You may also break out into a cold sweat, pain or discomfort in the jaw, neck, or back, pain or discomfort in one or both arms or shoulders, or experience shortness of breath.

Source: CDC

Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical. The aim of this study was to determine whether hostility was a predictor of ACS recurrence and mortality.

This was one of the largest and most comprehensive studies examining the relationship between hostility and outcomes in heart attack patients. It was a secondary analysis of data from the PROMOTION trial. The study included 2,321 heart attack survivors from a large randomized clinical trial of an intervention designed to reduce pre-hospital delay among patients who were experiencing ACS. Hostility was measured at baseline using the Multiple Adjective Affect Checklist (MAACL). Patients were followed for 24 months for recurrent heart attacks and death. Researchers used Cox proportional hazards modeling to determine whether hostility was predictive of time to ACS recurrence or all-cause mortality.

The average age of participants was 67 years and 68% subjects were men. More than half of the patients (57%) were scored as hostile according to the MAACL. The majority of patients were married (73%), Caucasian (97%), men (68%), and had a mean age of 67 ± 11 years. Fifty-seven percent of participants scored as hostile based on the established MAACL cut point (mean score = 7.56 ± 3.8). Hostility was an independent predictor of all-cause mortality (p = < 0.039) but was not a predictor of ACS recurrence (p = 0.792).

Hostility was an independent predictor of dying from a second heart attack after adjusting for other factors that could affect the relationship including sex, age, education, marital status, diabetes, high blood pressure, and smoking. The paper states that anxiety and depression are emotional states typically evaluated in patients with heart disease. Adding an assessment of hostility may identify patients at risk for premature death. Educating patients on the potential impact of hostility could motivate behavioral changes.

Source: American Heart Association

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