People with Hostile Behavior Could Be at High Risk of Death after a Second Heart Attacks

Reviewed by Dr. Victor Marchione, MD.
Written by Mat Lecompte
Published on

Closeup portrait, angry young sitting woman pissed off by drivers in front of her and gesturing with hands. Road rage traffic jam concept. Woman is driving her car very aggressive and gives gesture with his fistImproving hostile behavior may reduce the risk of death after a second heart attack, according to new research published in the European Journal of Cardiovascular Nursing. This study, one of the largest and most comprehensive of its kind, examined the relationship between hostility and the effect it had on heart attack patients.

Hostility is a personality trait that includes being irritable, sarcastic, cynical, resentful, or impatient. The study author, Dr. Tracey Vitori, spoke about the research, saying, “We know that taking control of lifestyle habits improves the outlook for heart attack patients and our study suggests that improving hostile behaviors could also be a positive move.”

The study included 2,321 participants who were all heart attack survivors. Hostility was measured using the Multiple Adjective Affect Checklist (MAACL), and all patients were followed for 24 months for recurrent heart attack and death. The average age of participants was 67 years, and 68% were men. Out of all participants, 57% were scored as hostile, according to the MAACL.

After adjusting for factors that could affect the relationship, including sex, age, education, diabetes, high blood pressure, and smoking, researchers found that hostility was an independent predictor of dying from a second heart attack.

Dr. Vitori noted that hostility did not predict recurrent heart attacks. She said: “Hostility has been linked with cardiovascular disease since the 1950s, but we still don’t fully understand why. Our study shows that hostility is a common trait in heart attack survivors and is associated with poor outcomes. More research is needed on how this characteristic affects the body.”

By educating patients on the potential impact of hostility on the risk of death, researchers believe it could help to motivate behavioral changes. Anxiety and depression are emotional states that are typically found in patients with heart disease, and researchers believe that adding an assessment of hostility may identify patients who are at risk for premature death.

Managing Hostile Behavior

With mounting evidence of how lifestyle changes can help to reduce risk of cardiovascular events in high-risk patients, this study outlines the importance of managing hostile behaviors. Other lifestyle changes include smoking cessation, increasing physical activity, and eating a healthy, well-balanced diet.

Many physical and behavioral stress problems are known to be directly influenced by stress, anger, and hostility, not just an increased risk of death after a second heart attack. For example, patients with gastrointestinal or stomach problems have a high correlation with anger.

Most people believe that they have little to no control over their hostility, but like all emotions and behaviors, a person can learn to better control their temperament through training and practice. By learning some easy techniques and changing lifestyle habits, anger and hostility may be reduced, thereby reducing any health risks related to the emotions.


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On any matter relating to your health or well-being, please check with an appropriate health professional. No statement herein is to be construed as a diagnosis, treatment, preventative, or cure for any disease, disorder or abnormal physical state. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. Dr. Marchione and the doctors on the Bel Marra Health Editorial Team are compensated by Bel Marra Health for their work in creating content, consulting along with formulating and endorsing products.

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