Hostility and Glucose The Prospective Contribution of Hostility Characteristics to Fasting Glucose: The Moderating Role of Marital Status

Objective: To assess whether psychological constructs of hostility, anger, type A behavior pattern, and depressive symptom severity 1) were associated with concurrent and prospective fasting glucose levels and 2) whether this association was moderated by marital status. Research Design and Methods: Participants were 485 healthy men (mean age = 59 [SD=7] years) without a history of heart disease, diabetes, or taking related medications in the VA Normative Aging Study. Their fasting glucose levels between 1986 and 1995 were examined. Hierarchical linear regressions were conducted to investigate whether hostility, anger, type A behavior, and depressive symptoms were associated with concurrent fasting glucose levels as well as fasting glucose 9 years later, controlling for standard sociodemographic and biomedical covariates, including baseline fasting glucose, age, education, marital status, BMI, total cholesterol, and systolic blood pressure. Results: Although none of the psychological variables were associated with concurrent fasting glucose, Cook-Medley hostility (β=0.105), anger (β=0.091), and type A behavior (β=0.152) each were associated with prospective fasting glucose at 9 years later, controlling for standard covariates. Depressive symptom severity was not associated with either concurrent or follow-up glucose levels. Further analysis showed that marital status moderated the effects of these characteristics on follow-up fasting glucose, such that hostility, anger, and type A behavior were significant only among those who were not married (βs=0.348, 0.444, 0.439, respectively; all Ps < 0.001). Conclusions: Hostility, anger, and type A behavior appear to be independent risk factors for impaired glucose metabolism among unmarried older men. 3 ounting evidence has demonstrated that some psychological factors are independently and prospectively associated with the incidence of type 2 diabetes and coronary artery disease (CAD). For example, depression and anger have been shown to be associated with incidence of type 2 diabetes (1,2). Hostility, anger, type A behavior, and depressive symptoms have also been found to predict CAD onset (3). Impaired glucose metabolism, indicated by insulin resistance and elevated glucose levels, is well recognized as a precursor of both type 2 diabetes and CAD (4), and a defining feature of the metabolic syndrome (5). Hyperglycemia has also been linked to a number of pathophysiologic processes giving rise to both type 2 diabetes and CAD, including obesity, dyslipidemia, hypertension, inflammation, and procoagulation (6). Despite its prominent role in disease development, there is a dearth of research exploring whether impaired glucose metabolism is associated with the psychosocial variables implicated in the onset of type 2 diabetes …