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Chen M, Wang Z, Xu H, Li W, Teng P, Ma L. Genetics of mood instability and risk of cardiovascular diseases: A univariable and multivariable Mendelian randomization study. J Affect Disord 2024; 347:406-413. [PMID: 37992774 DOI: 10.1016/j.jad.2023.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are significant contributors to global disability and mortality. In addition to traditional cardiovascular risk factors, emerging evidence has suggested that mental health plays a critical role as a risk factor for CVDs. The present study aimed to determine the associations between mood instability and CVDs using Mendelian randomization (MR) analysis. METHODS As instrumental variables, we used 62 independent single-nucleotide polymorphisms associated with mood instability at the genome-wide significance threshold in the UK Biobank. Summary-level data for seven CVDs were obtained from the publicly available genome-wide association studies. The estimates were pooled by using a random-effects inverse-variance weighted method. The results were further validated in sensitivity analysis where different MR methods were compared. RESULTS After correcting for multiple testing, our analysis revealed that genetic liability to mood instability was associated with increased odds of six cardiovascular diseases, including deep vein thrombosis (odds ratio (OR) 1.21; confidence interval (CI) 1.03-1.42), pulmonary embolism (OR 1.42; 95 % CI 1.09-1.85), heart failure (OR 1.20; 95 % CI 1.09-1.32), arterial hypertension (OR 1.22; 95 % CI 1.11-1.34), myocardial infarction (OR 1.25; 95 % CI 1.11-1.40), and coronary artery disease (OR 1.25; 95 % CI 1.13-1.39). Further, the genetic liability to mood instability was associated with HDL cholesterol, triglycerides, body mass index, smoking, and depression. In multivariable MR models, the association between genetic liability to mood instability and CVDs remained independent from those cardiovascular risk factors. CONCLUSION The present MR study suggests potential causal associations of genetic liability to mood instability with increased risk of a broad range of CVDs.
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Affiliation(s)
- Miao Chen
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Wang
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongfei Xu
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Li
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Teng
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Liu J, Cai D. Causal relationship of cereal intake and type with cardiovascular disease: a Mendelian randomization study. Front Nutr 2024; 10:1320120. [PMID: 38323222 PMCID: PMC10844472 DOI: 10.3389/fnut.2023.1320120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024] Open
Abstract
Background Observational studies have suggested that cereal consumption is associated with a reduced risk of cardiovascular disease (CVD). However, the potential causal relationship is not clear. We aimed to investigate the association of cereal intake and cereal type with CVD risk. Methods Two-step Mendelian randomization (MR) analysis was performed to confirm the causal association of cereal intake and cereal type with the risk of several common CVDs. Furthermore, two-step MR analysis was used to explore the mediating effect of cardiovascular metabolic factors, and multivariable MR analysis was used to assess the impact of socioeconomic status, such as education and income, on the causal association. Results The MR analysis indicated that genetically predicted cereal intake is associated with reduced risk of large artery stroke (LAS) (odd ratio (OR): 0.421; 95% confidence interval (CI) [0.193, 0.918]; p = 0.030), and muesli as the primary cereal intake is associated with reduced risk of coronary heart disease (CHD) (OR: 0.100; 95% CI [0.023, 0.437]; p = 0.002), myocardial infarction (MI) (OR: 0.101; 95% CI [0.020, 0.509]; p = 0.005), heart failure (OR: 0.210; 95% CI [0.064, 0.684]; p = 0.010), ischemic stroke (IS) (OR: 0.130; 95% CI [0.029, 0.591]; p = 0.008), LAS (OR: 0.017; 95% CI [0.0004, 0.737]; p = 0.034), and small-vessel stroke (OR: 0.021; 95% CI [0.001, 0.708]; p = 0.005). In contrast, genetically predicted biscuits as the primary cereal intake increased the risk of CHD (OR: 6.557; 95% CI [1.197, 36.031]; p = 0.031), and other cereals, such as cornflakes, as the primary cereal intake increased the risk of CHD (OR: 3.803; 95% CI [1.194, 12.111]; p = 0.024), MI (OR: 4.240; 95% CI [1.185, 15.174]; p = 0.026), stroke (OR: 3.154; 95% CI [1.070, 9.298]; p = 0.037), and IS (OR: 3.736; 95% CI [1.185, 11.782]; p = 0.024). Multivariable MR analysis underscored the significant role of education and income in the causal association, and two-step MR analysis indicated that body mass index, lipids, and blood glucose exerted important mediating effects in the causal association. Conclusion The findings of our study underscore the causal beneficial influence of muesli as the primary cereal intake on CVDs. A reasonable consumption of muesli may provide primary prevention of CVDs.
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Affiliation(s)
| | - Dihui Cai
- Department of Cardiology, Ningbo Medical Center of Lihuili Hospital, Ningbo, Zhejiang, China
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Cai D, Fu Y, Song Y, Lin H, Ba Y, Lian J. A causal relationship between irritability and cardiovascular diseases: a Mendelian randomization study. Front Cardiovasc Med 2023; 10:1174329. [PMID: 37324625 PMCID: PMC10267866 DOI: 10.3389/fcvm.2023.1174329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Observational studies have suggested that irritability is associated with a higher risk of cardiovascular disease (CVD). However, the potential causal association is not clear. Therefore, we used Mendelian randomization (MR) analysis to assess the causal association of irritability with CVD risk. Methods A two-sample MR analysis was performed to confirm the causal association of irritability with the risk of several common CVDs. The exposure data were derived from the UK biobank involving 90,282 cases and 232,386 controls, and outcome data were collected from the published genome-wide association studies (GWAS) and FinnGen database. Inverse-variance weighted (IVW), MR-Egger, and weighted median methods were performed to assess the causal association. Furthermore, the mediating effect of smoking, insomnia, and depressed affect was explored by using a two-step MR. Results The MR analysis indicated that genetically predicted irritability increased the risk of CVD, including coronary artery disease (CAD) (Odds ratio, OR: 2.989; 95% confidence interval, CI: 1.521-5.874, p = 0.001), myocardial infarction (MI) (OR: 2.329, 95% CI: 1.145-4.737, p = 0.020), coronary angioplasty (OR: 5.989, 95% CI: 1.696-21.153, p = 0.005), atrial fibrillation (AF) (OR: 4.646, 95% CI: 1.268-17.026, p = 0.02), hypertensive heart disease (HHD) (OR: 8.203; 95% CI: 1.614-41.698, p = 0.011), non-ischemic cardiomyopathy (NIC) (OR: 5.186; 95% CI: 1.994-13.487, p = 0.001), heart failure (HF) (OR: 2.253; 95% CI: 1.327-3.828, p = 0.003), stroke (OR: 2.334; 95% CI: 1.270-4.292, p = 0.006), ischemic stroke (IS) (OR: 2.249; 95% CI: 1.156-4.374, p = 0.017), and ischemic stroke of large-artery atherosclerosis ISla (OR: 14.326; 95% CI: 2.750-74.540, p = 0.002). The analysis also indicated that smoking, insomnia, and depressed affect play an important role in the process of irritability leading to cardiovascular disease. Conclusion Our findings support the first genetic evidence of the causality of genetically predicted irritability with the risk of developing into CVDs. Our results deliver a viewpoint that more early active interventions to manage an individual's anger and related unhealthy lifestyle habits are needed to prevent the occurrence of adverse cardiovascular events.
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Titova OE, Baron JA, Michaëlsson K, Larsson SC. Anger frequency and risk of cardiovascular morbidity and mortality. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac050. [PMID: 36117950 PMCID: PMC9472789 DOI: 10.1093/ehjopen/oeac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 11/14/2022]
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.
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Affiliation(s)
- Olga E Titova
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
| | - John A Baron
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
- Department of Medicine, University of North Carolina School of Medicine , Chapel Hill, NC , USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC , USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
| | - Susanna C Larsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
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Kwon CY, Suh HW, Kim JW, Chung SY. Anti-anger Effects of Herbal Medicine: A Mini-Review of Rat Studies. Chin J Integr Med 2022; 28:263-271. [PMID: 35084699 DOI: 10.1007/s11655-022-3506-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze the available data on the anti-anger effects of herbal medicines (HMs) as well as their underlying mechanisms in rat models. METHODS From 6 electronic databases [PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang, Oriental Medicine Advanced Searching Integrated System (OASIS), and Research Information Sharing Service (RISS)], relevant animal experiments were searched by using "anger," "rats," and "animal" as search keywords. The last search was conducted on November 22, 2019, and all experiments involving rat models of anger and treatment using HMs published until the date of the search were considered. RESULTS A total of 24 studies with 16 kinds of HMs were included. Most studies have used the "tail irritating method" and "social isolation and resident intruder" method to establish anger models. According to the included studies, the therapeutic mechanisms of HMs for anger regulation and important herbs by their frequency and/or preclinical evidence mainly incladed regulation of hemorheology (Bupleuri Radix, Paeoniae Radix Alba, and Glycyrrhizae Radix), regulation of sex hormones (Bupleuri Radix, Cyperi Rhizoma, and Paeoniae Radix Alba), regulation of neurotransmitters (Cyperi Rhizoma), regulation of anger-related genes (Bupleuri Radix, Glycyrrhizae Radix, and Paeoniae Radix Alba), and other effects. Overall, Liver (Gan) qi-smoothing herbs including Bupleuri Radix and Cyperi Rhizoma were the most frequently used. CONCLUSIONS This review found the frequent methods to establish an anger model, and major mechanisms of anti-anger effects of HMs. Interestingly, some Liver qi-smoothing herbs have been frequently used to investigate the anti-anger effects of HM. These findings provide insight into the role and relevance of HMs in the field of anger management.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, 47227, Republic of Korea
| | - Hyo-Weon Suh
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdonggu, Seoul, 05278, Republic of Korea
| | - Jong Woo Kim
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdonggu, Seoul, 05278, Republic of Korea
| | - Sun-Yong Chung
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdonggu, Seoul, 05278, Republic of Korea.
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1124-1141. [DOI: 10.1093/eurjpc/zwac006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
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Pollock BD, Chen W, Harville EW, Bazzano LA. Associations between Hunter Type A/B Personality and Cardiovascular Risk Factors from Adolescence through Young Adulthood. Int J Behav Med 2017; 24:593-601. [PMID: 28127708 PMCID: PMC6791370 DOI: 10.1007/s12529-017-9636-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Type A personality, characterized by action-oriented tendencies, has been linked to cardiovascular disease in middle-aged and elderly adults. Alternatively, limited research has tested whether personality type A/B and cardiovascular (CVD) risk are linked prior to adulthood. Therefore, we used the Hunter-Wolf A/B personality score to determine whether personality type A/B is associated with traditional CVD risk factors during adolescence, and more importantly if personality type, or its individual type A components, are associated with cardiovascular risk through young adulthood. This study is the first to assess personality type A/B on a continuous spectrum with regard to its relationship with cardiovascular disease risk, as well as the first to examine this association in a biracial, adolescent population. METHODS Subjects (3396) from the Bogalusa Heart Study were surveyed from 1984 to 1986, and multivariable regression was used to test adjusted, cross-sectional associations between personality type A/B, as determined by Hunter-Wolf A/B personality questionnaire, and CVD risk factors during adolescence. To test whether associations existed longitudinally, subjects were followed through 2007, and general estimating equation (GEE) models were used to examine the associations of personality type A/B with CVD risk factors, as well as with Framingham risk score as a global score of CVD risk. The component traits of type A personality (leadership, hard-driving, eagerness-energy, and impatience-aggression) were tested individually to determine their independent, longitudinal associations with global CVD risk. RESULTS Baseline mean (SD) age was 15.9(5.2). Mean( SD) Hunter-Wolf score in was 96.9 (11.6). After adjustment, more type A Hunter-Wolf scores were cross-sectionally associated with lower alcohol consumption (p = 0.03), female gender (p < 0.0001), and black race (p < 0.0001) in adolescence. After follow-up (median = 11 years), personality type A/B as the continuous Hunter-Wolf score was non-linearly associated with young adult BMI (p = 0.01), fasting blood glucose (p < 0.01), and Framingham score (p = 0.05). Of the type A components, leadership and hard-driving were non-linearly associated with Framingham risk at follow-up (both p < 0.0001). CONCLUSIONS Adolescent personality type A is associated with female gender and black race. Generally, type A children have higher CVD risk during young adulthood, though this relationship is non-linear. Additionally, adolescents exhibiting strong leadership-oriented personality traits have worse cardiovascular risk profiles in early adulthood, whereas hard-driving adolescent personalities are protective of young adult CVD risk. Our results warrant consideration of personality as a continuous, non-categorical, trait in studies of cardiovascular disease.
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Affiliation(s)
- Benjamin D Pollock
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA.
| | - Wei Chen
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
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Keith F, Krantz DS, Chen R, Harris KM, Ware CM, Lee AK, Bellini PG, Gottlieb SS. Anger, hostility, and hospitalizations in patients with heart failure. Health Psychol 2017. [PMID: 28650197 DOI: 10.1037/hea0000519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Heart failure patients have a high hospitalization rate, and anger and hostility are associated with coronary heart disease morbidity and mortality. Using structural equation modeling, this prospective study assessed the predictive validity of anger and hostility traits for cardiovascular and all-cause rehospitalizations in patients with heart failure. METHOD 146 heart failure patients were administered the STAXI and Cook-Medley Hostility Inventory to measure anger, hostility, and their component traits. Hospitalizations were recorded for up to 3 years following baseline. Causes of hospitalizations were categorized as heart failure, total cardiac, noncardiac, and all-cause (sum of cardiac and noncardiac). RESULTS Measurement models were separately fit for Anger and Hostility, followed by a Confirmatory Factor Analysis to estimate the relationship between the Anger and Hostility constructs. An Anger model consisted of State Anger, Trait Anger, Anger Expression Out, and Anger Expression In, and a Hostility model included Cynicism, Hostile Affect, Aggressive Responding, and Hostile Attribution. The latent construct of Anger did not predict any of the hospitalization outcomes, but Hostility significantly predicted all-cause hospitalizations. Analyses of individual trait components of each of the 2 models indicated that Anger Expression Out predicted all-cause and noncardiac hospitalizations, and Trait Anger predicted noncardiac hospitalizations. None of the individual components of Hostility were related to rehospitalizations or death. CONCLUSION The construct of Hostility and several components of Anger are predictive of hospitalizations that were not specific to cardiac causes. Mechanisms common to a variety of health problems, such as self-care and risky health behaviors, may be involved in these associations. (PsycINFO Database Record
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Affiliation(s)
- Felicia Keith
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Rusan Chen
- Center for New Designs in Learning and Scholarship, Georgetown University
| | | | - Catherine M Ware
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Amy K Lee
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Paula G Bellini
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Stephen S Gottlieb
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine
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Genovese T, Dalrymple K, Chelminski I, Zimmerman M. Subjective anger and overt aggression in psychiatric outpatients. Compr Psychiatry 2017; 73:23-30. [PMID: 27855338 DOI: 10.1016/j.comppsych.2016.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression. METHOD 3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N=3800) and Axis II (N=2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression. RESULTS Almost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders. CONCLUSIONS Anger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment.
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Affiliation(s)
- Timothy Genovese
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI.
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Associations between Hunter Type A/B Personality and Cardiovascular Risk Factors from Adolescence through Young Adulthood. Int J Behav Med 2017. [PMID: 28127708 DOI: 10.1007/s12529‐017‐9636‐5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Type A personality, characterized by action-oriented tendencies, has been linked to cardiovascular disease in middle-aged and elderly adults. Alternatively, limited research has tested whether personality type A/B and cardiovascular (CVD) risk are linked prior to adulthood. Therefore, we used the Hunter-Wolf A/B personality score to determine whether personality type A/B is associated with traditional CVD risk factors during adolescence, and more importantly if personality type, or its individual type A components, are associated with cardiovascular risk through young adulthood. This study is the first to assess personality type A/B on a continuous spectrum with regard to its relationship with cardiovascular disease risk, as well as the first to examine this association in a biracial, adolescent population. METHODS Subjects (3396) from the Bogalusa Heart Study were surveyed from 1984 to 1986, and multivariable regression was used to test adjusted, cross-sectional associations between personality type A/B, as determined by Hunter-Wolf A/B personality questionnaire, and CVD risk factors during adolescence. To test whether associations existed longitudinally, subjects were followed through 2007, and general estimating equation (GEE) models were used to examine the associations of personality type A/B with CVD risk factors, as well as with Framingham risk score as a global score of CVD risk. The component traits of type A personality (leadership, hard-driving, eagerness-energy, and impatience-aggression) were tested individually to determine their independent, longitudinal associations with global CVD risk. RESULTS Baseline mean (SD) age was 15.9(5.2). Mean( SD) Hunter-Wolf score in was 96.9 (11.6). After adjustment, more type A Hunter-Wolf scores were cross-sectionally associated with lower alcohol consumption (p = 0.03), female gender (p < 0.0001), and black race (p < 0.0001) in adolescence. After follow-up (median = 11 years), personality type A/B as the continuous Hunter-Wolf score was non-linearly associated with young adult BMI (p = 0.01), fasting blood glucose (p < 0.01), and Framingham score (p = 0.05). Of the type A components, leadership and hard-driving were non-linearly associated with Framingham risk at follow-up (both p < 0.0001). CONCLUSIONS Adolescent personality type A is associated with female gender and black race. Generally, type A children have higher CVD risk during young adulthood, though this relationship is non-linear. Additionally, adolescents exhibiting strong leadership-oriented personality traits have worse cardiovascular risk profiles in early adulthood, whereas hard-driving adolescent personalities are protective of young adult CVD risk. Our results warrant consideration of personality as a continuous, non-categorical, trait in studies of cardiovascular disease.
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Ogilvie RP, Everson-Rose SA, Longstreth WT, Rodriguez CJ, Diez-Roux AV, Lutsey PL. Psychosocial Factors and Risk of Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Circ Heart Fail 2015; 9:e002243. [PMID: 26699386 DOI: 10.1161/circheartfailure.115.002243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/07/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease but not for HF. METHODS AND RESULTS We examined the relationship between psychological status and incident HF among 6782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales, and physician reviewers adjudicated incident HF events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow-up of 9.3 years, 242 participants developed incident HF. There was no association between psychosocial factors and HF hazard ratios (95% confidence interval) for the highest versus lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high versus low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident HF, but there was no association for those with good/very good/excellent self-reported health. CONCLUSIONS Overall, these psychosocial factors were not significantly associated with incident HF. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of HF. Future research with greater statistical power is necessary to replicate these findings and seek explanations.
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Affiliation(s)
- Rachel P Ogilvie
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
| | - Susan A Everson-Rose
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - W T Longstreth
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Carlos J Rodriguez
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Ana V Diez-Roux
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
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Rafanelli C, Gostoli S, Tully PJ, Roncuzzi R. Hostility and the clinical course of outpatients with congestive heart failure. Psychol Health 2015; 31:228-38. [PMID: 26387801 DOI: 10.1080/08870446.2015.1095299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The role of depression and quality of life on clinical outcomes of congestive heart failure (CHF) is well recognised. However, there are fewer studies investigating the prognostic role of subclinical psychological distress and well-being impairments. The aims of this study were to evaluate clinical/subclinical psychological distress and well-being in CHF outpatients, and the influence of these psychological factors on adverse cardiac events (re-hospitalisation, cardiac death), at 4-year follow-up. DESIGN Sixty-eight CHF outpatients underwent psychological assessment at baseline and, after 4 years, information about cardiac events was collected in 60 patients by means of clinical records. MAIN OUTCOME MEASURES Psychological assessment included structured clinical interview for DSM (major/minor depression), Interview for diagnostic criteria for psychosomatic research (demoralisation), symptom questionnaire, psychological well-being scales. RESULTS At follow-up, 39.7% of the baseline sample reported cardiovascular events (14 CHF-related re-hospitalisations and 13 cardiac deaths) and 5.9% other causes for death. Among the variables examined as potential risk factors for adverse cardiovascular outcomes, only hostility was significant, even after controlling for disease severity (hazard ratio = 2.38, 95%confidence interval: 1.04-5.45, p = .040). CONCLUSION In outpatients with CHF, psychological assessment should include both clinical and subclinical distress such as hostility, in order to better address psychological risk factors for cardiac outcomes.
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Affiliation(s)
- Chiara Rafanelli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Sara Gostoli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Phillip J Tully
- b Discipline of Medicine , University of Adelaide , Adelaide , Australia
| | - Renzo Roncuzzi
- c Division of Cardiology , Bellaria Hospital , Bologna , Italy
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