Hostility as a Predictor of Survival in Patients With Coronary Artery Disease

Department of Psychiatry, Duke University Medical Center, Box 2969, Durham, NC, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 09/2004; 66(5):629-32. DOI: 10.1097/01.psy.0000138122.93942.4a
Source: PubMed


This article presents a reanalysis of an earlier study that reported a nonsignificant relation between the 50-item Cook-Medley Hostility Scale (CMHS) and survival in a sample of coronary patients. Since publication of those results, there have been significant developments in the measurement of hostility that suggest that an abbreviated scale may be a better predictor of health outcomes. This study examined the ability of the total CMHS and an abbreviated form of the CMHS (ACM) to predict survival in a sample of patients with documented coronary artery disease (CAD) with increased statistical power.
Nine hundred thirty-six patients (83% were male; mean age = 51.48) with CAD who were followed for an average of 14.9 years. The ACM consisted of the combination of the cynicism, hostile attribution, hostile affect, and aggressive responding subscales that were identified in an earlier study (Barefoot et al. [1989]) by a rational analysis of the item content. The relation between hostility and survival was examined with Cox proportional hazard models (hazard ratios [HRs] based on a two standard deviation difference).
Controlling for disease severity, the ACM was a significant predictor for both CHD mortality (HR = 1.33, p <.009) and total mortality (HR = 1.28, p <.02). The total CMHS was only a marginally significant predictor of either outcome (p values < 0.06).
The results of this study suggest that hostility is associated with poorer survival in CAD patients, and it may be possible to refine measures of hostility in order to improve prediction of health outcomes.

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    • "That is: a hostility-heart disease relationship is proposed . Even in patients with cardiovascular disease, the existence of high hostility scores can be considered as a good predictor of survival time of patients: high scores are associated with lower survival (Boyle et al., 2004; Denollet, Gidron, Vrints, & Conraads, 2010). Hostility also influences recovery after stress. "
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    ABSTRACT: The main objective of this study was to analyze the impact of defensive hostility on cardiovascular response in a stressful situation. By measuring three of the most commonly used cardiovascular indexes (heart rate, systolic blood pressure and diastolic blood pressure) over three experimental phases (adaptation, task and recovery), the evolution of cardiovascular response was analyzed minute by minute throughout the entire experimental session, to check if the defensive hostility influences the cardiovascular function. Two scales were used: the Cook-Medley Composite Hostility Scale and the Marlowe-Crowne Social Desirability Scale. Based on the scores on these scales, there were formed four groups (high hostility and high defensiveness, high hostility and low defensiveness, low hostility and high defensiveness, and low hostility and low defensiveness). The stressful situation which was used in the task phase was a real academic examination (exam of the Psychology degree). The hypothesis was that cardiovascular response, activation and recovery, minute by minute, will be greater in hostile defensive women, with an intra-phase evolution profile characterized by maintenance or sensitization and slow recovery. Results show that defensive hostile individuals present the highest values in the physiological variables recorded, and less adaptive profiles.
    Anales de Psicologia 05/2015; 31(2):390. DOI:10.6018/analesps.31.2.158511 · 0.50 Impact Factor
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    • "disease since the 19 th century (Kemey & Shestyuk, 2010). Hostility is strongly associated with the progression of coronary artery disease (Boyle et al., 2004), high blood pressure, atherosclerosis, and coronary artery calcification (Suinn, 2001). Effect sizes can be as large as those associated with smoking and diet. "
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    ABSTRACT: Conflict is common in ongoing relationships because partners have shared history and interdependence. Yet, bonding strengthens the relationship such that partners can understand disapproval from one another and the relationship can survive partner disagreements (Canary, Cupach, & Serpe, 2001). Gottman’s (1994; 2011) extensive research involving 12 studies with more than 3,000 couples and another 4,000 couples in therapy has found that arguing does not predict the end of relationships; it is how people argue (e.g., arguing with contempt, sarcasm, or ridicule versus arguing with concern, empathy, and cooperative impulses) that predicts the ending of relationships.
    The influence of communication in physiology and health, Edited by James M. Honeycutt, Chris Sawyer, Shaughan A. Keaton, 01/2014: chapter 4; Peter Lang.
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    • "The role of these factors in CHD has been widely studied and are important in both the etiology and prognosis of CHD (Bobak and Marmot 2005; Kop 2003). The most commonly reported variables connected to increased CHD morbidity and mortality risks are depression and vital exhaustion (Appels et al. 2006; Brummett et al. 2005, Kuper et al. 2005), type D personality (Denollet 2005) and hostility (Boyle et al. 2004). Health-related quality of life (HRQL) is also a factor of high clinical relevance in this context. "
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    ABSTRACT: The aim of this study was to assess whether psychosocial factors and health-related quality of life (HRQL) differ between Roma and non-Roma coronary patients and to what degree socioeconomic status (SES) explains these differences. We included 138 patients out of 437 interviewed: 46 Roma, all with low SES, 46 non-Roma with low SES, and 46 non-Roma with high SES. Groups were matched for age, gender and education. The GHQ-28 was used for measuring psychological well-being, the Maastricht interview for vital exhaustion, the type D questionnaire and the Cook-Medley scale for personality and the SF-36 for HRQL. SES was indicated by income and education, and disease severity by ejection fraction. ANOVA and linear regression were used. Roma scored poorly compared to non-Roma in psychological well-being, vital exhaustion and HRQL (p ≤ 0.001); however, these differences could be to a substantial extent explained by SES. With regard to personality traits, ethnicity and SES played a less significant role. The adverse quality of life among Roma coronary patients may warrant additional care, which should target their low SES but also other factors related to their ethnic background, such as culture and living conditions.
    International Journal of Public Health 10/2010; 55(5):373-80. DOI:10.1007/s00038-010-0153-4 · 2.70 Impact Factor
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