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. 2022 Aug 6;2(4):oeac050.
doi: 10.1093/ehjopen/oeac050. eCollection 2022 Jul.

Anger frequency and risk of cardiovascular morbidity and mortality

Olga E Titova  1 , John A Baron  1   2   3 , Karl Michaëlsson  1 , Susanna C Larsson  1   4
Affiliations

Anger frequency and risk of cardiovascular morbidity and mortality

Olga E Titova et al. Eur Heart J Open. .

Abstract

Aims: Anger may increase the risk of cardiovascular diseases (CVDs) but previous findings are inconclusive and large prospective studies are needed. We investigated whether frequency of strong anger is associated with the incidence of specific CVDs and CVD mortality, and if sex, age, and cardiometabolic risk factors modify these associations.

Methods and results: We used data from a population-based cohort of 47 077 Swedish adults (56-94 years of age) who completed questionnaires regarding their experience of anger, lifestyle habits, and health characteristics. Participants were followed for incident cardiovascular outcomes and death up to 9 years through linkage to the Swedish National Patient and Death Registers. Hazard ratios and confidence intervals adjusted for potential confounders were assessed.In multivariable analyses, frequent episodes of strong anger were associated with an increased risk of heart failure, atrial fibrillation, and CVD mortality [hazard ratios (95% confidence intervals) = 1.19 (1.04-1.37), 1.16 (1.06-1.28), and 1.23 (1.09-1.40), respectively]. The link between anger frequency and heart failure was more pronounced in men and participants with a history of diabetes. No evidence of an independent association of anger frequency with risk of myocardial infarction, aortic valve stenosis, and abdominal aortic aneurysm was found.

Conclusion: Our findings indicate that anger may contribute to the development of specific CVDs and CVD mortality, especially heart failure in men and in those with diabetes.

Keywords: Anger; Cardiovascular disease; Cardiovascular mortality; Cohort; Diabetes; Sex.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Multivariable hazard ratio (95% confidence interval) of cardiovascular diseases and cardiovascular disease mortality according to reports of frequency of strong anger. The Cox proportional hazards regression model was adjusted for age (underlying time scale), sex (as a stratification variable), education, employment status, cigarette smoking, alcohol intake, walking/bicycling, exercise, body mass index, and history of hypercholesterolaemia, hypertension, diabetes, and depression. CI, confidence interval; HR, hazard ratio.
Figure 2
Figure 2
Multivariable hazard ratio (95% confidence interval) of heart failure according to anger frequency stratified by sex and history of diabetes. The Cox proportional hazards regression model was adjusted for age (underlying time scale), sex (as a stratification variable, analysis by diabetes history), education, employment status, cigarette smoking, alcohol intake, walking/bicycling, exercise, body mass index, and history of hypercholesterolaemia, hypertension, diabetes (analysis by sex), and depression. CI, confidence interval; HR, hazard ratio; DM, diabetes mellitus.
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