The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence

J Am Coll Cardiol. 2009 Mar 17;53(11):936-46. doi: 10.1016/j.jacc.2008.11.044.


Objectives: This review aimed to evaluate the association between anger and hostility and coronary heart disease (CHD) in prospective cohort studies using quantitative methods.

Background: The harmful effect of anger and hostility on CHD has been widely asserted, but previous reviews have been inconclusive.

Methods: We searched general bibliographic databases: MEDLINE, PsycINFO, Web of Science, and PubMed up to November 2008. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations.

Results: There were 25 studies (21 articles) investigating CHD outcomes in initially healthy populations and 19 studies (18 articles) of samples with existing CHD. Anger and hostility were associated with increased CHD events in the healthy population studies (combined hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.05 to 1.35, p = 0.008) and with poor prognosis in the CHD population studies (HR: 1.24; 95% CI: 1.08 to 1.42, p = 0.002). There were indications of publication bias in these reports, although the fail-safe numbers were 2,020 and 750 for healthy and disease population studies, respectively. Intriguingly, the harmful effect of anger and hostility on CHD events in the healthy populations was greater in men than women. In studies of participants with CHD at baseline that controlled fully for basal disease status and treatment, the association of anger and hostility with poor prognosis persisted.

Conclusions: The current review suggests that anger and hostility are associated with CHD outcomes both in healthy and CHD populations. Besides conventional physical and pharmacological interventions, this supports the use of psychological management focusing on anger and hostility in the prevention and treatment of CHD.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anger*
  • Coronary Disease / epidemiology
  • Coronary Disease / prevention & control
  • Coronary Disease / psychology*
  • Female
  • Hostility*
  • Humans
  • Male
  • Risk Factors
  • Stress, Psychological / epidemiology