Background: Atherosclerotic cardiovascular disease is prevalent among African Americans (AAs). Findings are mixed regarding the relationship between anger expression and peripheral atherosclerosis, as well as coronary atherosclerosis, as measured by coronary artery calcification (CAC). In addition, this relationship is unknown among AAs.
Hypothesis: Higher anger levels are positively associated with CAC and abdominal-iliac artery calcification (AAC) among AAs.
Methods: Using the Jackson Heart Study cohort (N=5301), we stratified 1809 participants who completed the Spielberger Anger Expression scale at baseline into four quartiles. The scale consists of 16 items, measuring anger-in and anger-out, with higher scores representing higher frequencies of anger expression. Total anger (anger-in and anger-out) quartiles were measured against CAC and AAC using ordinal logistic regression. CAC and AAC were categorized as: 0, 1-10, 11-100, 101-300, and greater than 300. Models were adjusted for potential confounding variables (age, sex, smoking, alcohol, diabetes mellitus, hypertension, and coronary heart disease).
Results: The final study sample consisted of 34% (615 of 1809) male with a mean age of 54.0 (SD 10.79). Higher total anger was inversely associated with age and hypertension, but positively related to alcohol use and smoking status. Unadjusted analysis showed that total anger quartiles and anger-in quartiles were inversely related to CAC and AAC. The association of anger with CAC and AAC was non-significant after adjustment for confounders (Table).
Conclusion: Before adjustment, higher anger levels showed a protective effect against coronary and aortic atherosclerosis. However, this relationship was no longer significant after adjustment for confounders suggesting that age and hypertension played a major role in the presence of atherosclerosis in this AA population. Future studies should investigate whether other negative emotional expressions are associated with atherosclerosis in AAs