Association of Hostility With Coronary Artery Calcification in Young Adults The CARDIA Study

HOSTILITY IS A PERSONALITY and character trait with attitudinal (cynicism and mistrust of others), emotional (anger), and behavioral (overt and repressed aggression) components. In epidemiological studies, hostility has been frequently measured with the Cook-Medley questionnaire, an empirical scale originally designed to characterize mistrustful attitudes. High hostility level is related to increased risk of angiographically documented coronary atherosclerosis, essential hypertension, coronary artery disease (CAD) incidence, and allcause mortality. However, 3 studies have reported no relationship between hostility and CAD outcomes. It has also been shown that hostility is a predictor of restenosis after coronary angioplasty and of carotid intima media thickness among healthy postmenopausal women and middle-aged men. Several mechanisms have been proposed to explain why hostility may increase cardiovascular risk, including concomitant unhealthful lifestyle behaviors. For example, Everson et al have shown that the association between cynical distrust and cardiovascular outcomes was explained by simultaneous adjustment for smoking, alcohol consumption, physical activity, and body mass index. Our objective was to examine the association of hostile attitudes with coronary artery calcification, a marker of subclinical atherosclerosis, among a subset of participants in the Coronary Author Affiliations: Kaiser Permanente Medical Care Program, Northern California Region, Oakland, Calif (Drs Iribarren and Sidney); Department of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Bild); Department of Family and Community Medicine, Northwestern University Medical School, Chicago, Ill (Dr Liu); Division of Preventive Medicine (Dr Markovitz) and School of Public Health (Dr Roseman), University of Alabama, Birmingham; and Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Dr Matthews). Corresponding Author and Reprints: Carlos Iribarren, MD, MPH, PhD, Kaiser Permanente Division of Research, 3505 Broadway, Oakland, CA 94611 (e-mail: [email protected]). Context Psychosocial factors, including personality and character traits, may play a role in the development and expression of coronary artery disease.