Download Anger predicts long-term mortality in patients with myocardial

Anger predicts long-term mortality in
patients with myocardial infarction
Franco Bonaguidi
Institute of Clinical Physiology, CNR
Pisa, Italy
DECLARATION OF CONFLICT
OF INTEREST
No conflict of interest
Background 1 – IFC, Personality
traits and prognosis
Religiosity is associated
with prolonged survival
in patients undergoing liver
transplantion
Bonaguidi F, Rovai D, et al .Liver Transpl. 2010;16:1158-63.
Anxiety and low
emotional sensitivity are
significant predictors of
8-year cardiac mortality
after AMI
Carpeggiani C, Bonaguidi F, et al. Eur Heart J. 2005;26:1612-7
Background 2 – Anger and CAD
•
A meta-analysis of 25 studies showed that anger and hostility are
associated with coronary heart disease outcomes both in healthy and
coronary heart disease population.
Chida Y, Steptoe A. J Am Coll Cardiol. 2009;53:936-46
•
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 (tendency to live negative emotions and strong
inhibition to express them)
Denollet J, et.al. Am J Cardiol 2010; 105:1555-1560.
Aim
To evaluate the predictive value of the
personality traits and behavioural responses in
patients who survived acute myocardial
infarction (AMI).
Methods
 228 patients (200 males, mean age=55±8 years) with AMI were
recruited from 13 Italian Coronary Care Units.

At pre-discharge patients were evaluated for psychological
aspects using both the 16PF questionnaire of Cattel (Extraversion;
Anxiety; Sensitivity;Self-control) and the Psy-Inventory scales
(Responsibility; Energy;Obsessiveness;Anger; stress-related
disturbances and time urgency).
 Clinical data, including traditional risk factors, peak cardiac necrosis
enzymes (CPK), left ventricular WMSI (by 2D-echocardiography)
and HRV were also considered in the study.
 Patients were followed-up for ten years (median 97 months).
 A Cox regression analysis was used to select the significant
predictors of future cardiac events.
Results
During the follow-up period, 51 events were
recorded
28 cardiac deaths
51 events
23 non fatal re-infarction)
FACTORS
RESULTS OF UNIVARIATE COX ANALYSIS
HR (95% CI)
p value
Age (yrs)
1.04 (1.00-1.08)
0.034
Gender (male)
2.66 (0.82-8.56)
0.100
Traditional risk factors (diabetes )
2.30 (1.12- 4.73)
0.023
Peak cardiac necrosis infarction
0.74 (0.42-1.29)
0.293
Left ventricular WMSI (2D Echo)
1.29 (0.75-2.25)
0.353
HR variability
1.04 (0.60-1.79)
0.889
Extraversion
1.14 (0.65-1.98)
0.654
Anxiety
1.83 (1.06-3.16)
0.029
Sensitivity
0.89 (0.52-1.54)
0.068
Self-control
0.83 (0.48-1.44)
0.505
Responsibility
0.59 (0.31-1.13)
0.114
Energy
0.69 (0.39-1.19)
0.181
Obsessiveness
1.08 (0.63-1.87)
0.767
Anger
2.35 (1.33-4.16)
0.003
Stress-related disturbances
1.96 (1.14-3.37)
0.154
Time-urgency
1.14 (0.66-1.97)
0.631
Psychological aspects (16 PF Cattel )
Psy-Inventory Scales
RESULTS OF MULTIVARIATE COX
ANALYSIS
Hazard Ratio
for patients (n=228)
Variable(95% Confidence Interval)
P
__________________________________________________
Anger
2.30
(1.29 to 4.08
0.004
Stress- related
Disturbances
1.90
(1.09 to 3.28)
0.022
1
Infaction-free survival
0.9
Anger -
0.8
78.5 %
0.7
p = 0.0025 Log Rank
Anger +
0.6
57.4 %
0.5
0
12
24
36
48
60
72
84
96
108
120
Months
Months
0
24
48
72
96
120
A-
123
91
81
76
69
16
A+
105
79
69
59
46
12
Conclusions
Anger and symptoms related to stress
increased the risk of new events, outperforming
all other clinical, imaging, laboratory and
electrocardiographic biomarkers.
These data provide epidemiological support to
targeted psychotherapy and/or behavioural
interventions in anger over-reactions and
suggest the inclusion of psychological aspects in
risk stratification models.
Consuma dentro te con la tua rabbia.
Consumed by your anger inside you
(Divina Commedia, Inferno, Canto VII, vv.7-9)
“Figlio, or tu vedi l’anime di color cui vinse l’ira”
“ Now seest thou son! The souls of those, whom anger overcame”
Divina commedia, Inferno, Canto VII, 118-119.
ì
Illustration by Paul Gustave Doré
ì
Inferno, gli iracondi, illustrazione di
ì Paul Gustave Doré,
Physiological and behavioural characteristics linking
anger with increased CHD risk
Physiological characteristics
Increased sympathetic nervous system function.
 Reduced parasympathetic nervous system function.
 Increased or dysregulated hypothalamic-pituitary-adrenal axis
activation.
Behavioural characteristics.
 Cigarette smoking
 Alchol consumption
 Increased energy intake