Anger, Hostility Linked To Atrial Fibrillation In Men

“This is the first study to show that certain measures of anger and hostility are related to the development of atrial fibrillation in men,” said lead author Elaine D. Eaker, Sc.D., of Eaker Epidemiology Enterprises, LLC, in Chili, Wis. She conducted the study with colleagues at Boston University and the Framingham Heart Study.

Atrial fibrillation is an irregular heart rhythm (arrhythmia) in which the two upper chambers of the heart quiver instead of beating effectively. Because blood isn’t completely pumped out of these chambers when the heart beats, blood can pool, form clots and increase stroke risk.

The condition affects about 2 million Americans and is increasing as the population ages. Previous research has suggested a possible link between atrial fibrillation and psychosocial stress.

Researchers tried to determine whether anger, hostility and Type A behavior are independently associated with the development of coronary heart disease, atrial fibrillation or death.

The analysis includes 1,769 men and 1,913 women in the Framingham Offspring Study, which involves the adult children and their spouses of the original participants in the National Heart, Lung, and Blood Institute’s Framingham Heart Study, begun in 1948. The Offspring participants completed psychological surveys during the third examination of the study, when their average age was 48.5 years and they had no signs of heart disease. Afterward, they were followed for 10 years for the incidence of coronary heart disease, atrial fibrillation, and death from any cause (total mortality).

After adjusting for known risk factors such as age and high blood pressure, researchers found several traits significantly increased the risk of atrial fibrillation in men. Those with higher feelings of hostility were 30 percent more likely to develop atrial fibrillation compared with men with lower hostility levels.

Hostility, as measured by the Minnesota Multiphasic Personality Inventory, is a generally contemptuous attitude toward other people. Hostile people expect the worst from others and feel a need to defend against it, agreeing with statements such as: I have often met people who were supposed to be experts who were no better than me; I frequently have worked under people who arrange things so they get all the credit; Some of my family members have habits that bother me and annoy me very much.

As for anger, men who scored high in “trait-anger” had a 10 percent greater risk of developing atrial fibrillation compared with men without increased anger. Participants scoring high on trait-anger described themselves as fiery- or quick-tempered, hot-headed, annoyed when slighted, furious when criticized, and wanting to hit someone when frustrated. Men high in trait-anger were also 20 percent more likely to have died from any cause during the study.

“There has been a perception that you can dissipate the negative health effects of anger by letting anger out instead of bottling it up,” Eaker said. “But that is definitely not the case in the men in this study – they were at higher risk not only of atrial fibrillation but of death from all causes.”

Also, men had a 20 percent increased chance of developing atrial fibrillation if they were rated high in “symptoms of anger,” reporting that their anger is often accompanied by bodily sensations such as shaking, headaches, and muscle tension.

In contrast, the researchers found no increased risk in men who rated high on Type A behavior. In this study, Type A behavior was assessed by the Bortner Rating Scale, which does not include anger and hostility but focuses on time urgency (always in a rush, hate having to wait) and competitiveness (hard-driving, strong need to excel, thinking about work all the time).

“Rather than concentrating on Type A behavior as a risk factor, it is probably more fruitful to start thinking about anger and hostility in men,” Eaker said.

Researchers found no significant association between anger, hostility or Type A behavior and a woman’s risk of dying or developing coronary heart disease or atrial fibrillation.

“We failed to find an association in women, but that may be because women develop heart disease later than men and our population was fairly young, with few instances of atrial fibrillation in women during the follow-up period,” Eaker said. “Without a larger or longer study, we cannot say definitely that the personality traits are not related to health outcomes in women.”

The known risks for atrial fibrillation are largely mechanical – anything that scars, stretches, or distorts the shape of the heart muscle can eventually result in arrhythmia, such as rheumatic fever, high blood pressure or heart surgery. The peak ages for developing atrial fibrillation are between 70 and 84. However, because this study was based on a middle-aged population, 66 percent of the cases occurred before age 60 and almost all were in people with no known heart disease.

Though these results need confirmation, Eaker said healthcare providers should know that some personality traits may be detrimental to health.

Co-authors are Lisa M. Sullivan, Ph.D.; Margaret Kelly-Hayes, Ed.D., R.N.; Ralph B. D’Agostino, Sr., Ph.D.; and Emelia J. Benjamin, M.D., Sc.M. The National Heart, Lung and Blood Institute funded the study.