The case for elevated risk of recurrent events in hostile patients is not as clear-cut as it is for disease incidence, partially because fewer studies have addressed the issue. Chaput and colleagues (2002) found that scores on the Cook Medley scale were an independent risk factor for recurrent events in postmenopausal women. Denollet and Brutsaert (1998) found that anger was one of several negative emotions conferring excess risk in MI patients. There have been some negative studies, however (e.g., Frasure-Smith and Lesperance, 2003), other researchers have observed the effect only under certain conditions. For example, two studies (Angerer et al, 2000; Boyle et al, 2004) found some hostility measures to be predictive while others were not, and Boyle and colleagues (2005) observed a stronger effect in younger patients. Although the picture painted by the literature is not completely clear, it is highly probable that hostility does convey increased risk of future coronary events in those with established disease. The exact conditions and aspects of hostility that maximize that risk are yet to be established.
The incidences of other cardiovascular disease have also been linked to various aspects of hostility. For example, Williams and colleagues (2002) found that trait anger predicted stroke incidence among participants in a large national study who were aged 60 or older, and Yan and colleagues (2003) observed a link between Cook Medley scores and the development of hypertension in the Coronary Artery Risk Development in Young Adults (CARDIA) study.
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