The evidence for an association between anger/hostility and cardiovascular disease has been derived from different CVD endpoints and different study designs. The most convincing evidence, of course, comes from studies that capture the so-called “hard” CVD endpoints, such as those which are objectively measured, quantifiable, and validated by an external criteria.

The most convincing evidence also comes from studies designed to include people who are free of CVD at baseline and who are followed over time for the occurrence of the disease (e.g., prospective study designs).

Johnson and colleagues: trait anger was positively associated with the LDL/HDL ratio and with triglycerides.

Durel and colleagues: trait anger was positively associated with systolic and diastolic blood pressure and with cardiovascular reactivity.

References for anger-CHD\cross-sectional studies

Johnson EH, Collier P, Nazzaro P, Gilbert DC. Psychological and physiological predictors of lipids in black males. J Behav Med. 1992;15:285-298.

Durel LA, Carver CS, Spitzer SB, Llabre MM, Weintraub JK, Saab PG, Schneiderman N. Associations of blood pressure with self-report measures of anger and hostility among black and white men and women. Health Psychol. 1989;8:557-575.

References for anger-CHD\prospective studies

Markovitz JH, Matthews KA, Wing RR, Kuller LH. Meilahn EN. Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. J Hypertens. 1991;9:399-406.

Haynes SG, Feinleib M, Kannel WB. The relationship of psychosocial factors to coronary heart disease in the Framingham study, III: 8-year incidence of coronary heart disease. Am J Epidemiol. 1980;11:37-58.

Kawachi I, Sparrow D, Spiro A III, Vokonas P, Weiss ST. A prospective study of anger and coronary heart disease: the Normative Aging Study. Circulation. 1996;94:2090-2095.

References for anger-CHD\laboratory and clinical studies

Verrier RL, Hagestad EL, Lown B. Delayed myocardial ischemia induced by anger. Circulation. 1987;75:249-254.

Ironson G, Taylor CB, Boltwood M, Bartzokis T, Dennis C, Chesney M, Spitzer S, Segall GM. Effects of anger on left ventricular ejection fraction in coronary artery disease. Am J Cardiol. 1992;70:281-285.

Boltwood MD, Taylor CB, Burke MB, Grogin H, Giacomini J. Anger report predicts coronary artery vasomotor response to mental stress in atherosclerotic segments. Am J Cardiol. 1993;72:249-254.

Gabbay RH, Krantz DS, Kop WJ, Hedges SM, Klein J, Gottdiener JS, Rozanski A. Triggers of myocardial ischemia during daily life in patients with coronary artery disease: physical and mental activities, anger and smoking. J Am Coll Cardiol. 1996;27:585-592.