ABC | Volume 111, Nº3, September 2018

Original Article Anger and Coronary Artery Disease in Women Submitted to Coronary Angiography: A 48-Month Follow-Up Karine Elisa Schwarzer Schmidt, Alexandre Schaan de Quadros, Mauro Regis Moura, Carlos Antonio Mascia Gottschall, Márcia Moura Schmidt Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS – Brazil Mailing Address: Márcia Moura Schmidt • Avenida Princesa Isabel, 370. Postal Code 90620-000, Santana, Porto Alegre, RS – Brazil E-mail: mmoura.pesquisa@gmail.com , mouramarcia050@gmail.com Manuscript received August 11, 2017, revised manuscript December 20, 2017, accepted April 11, 2018 DOI: 10.5935/abc.20180165 Abstract Background: Anger control was significantly lower in patients with coronary artery disease (CAD), regardless of traditionally known risk factors, occurrence of prior events or other anger aspects in a previous study of our research group. Objective: To assess the association between anger and CAD, its clinical course and predictors of low anger control in women submitted to coronary angiography. Methods: This is a cohort prospective study. Anger was assessed by use of Spielberger’s State-Trait Anger Expression Inventory (STAXI). Women were consecutively scheduled to undergo coronary angiography, considering CAD definition as ≥ 50% stenosis of one epicardial coronary artery. Results: During the study, 255 women were included, being divided into two groups according to their anger control average (26.99). Those with anger control below average were younger and had a family history of CAD. Patients were followed up for 48 months to verify the occurrence of major cardiovascular events. Conclusion: Women with CAD undergoing coronary angiography had lower anger control, which was associated with age and CAD family history. On clinical follow-up, event-free survival did not significantly differ between patients with anger control above or below average. (Arq Bras Cardiol. 2018; 111(3):410-416) Keywords: Anger; STAXI; Personality Inventory; Coronary Artery Disease/mortality. Introduction Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality of women in several countries, such as USA and Brazil. 1 There are more deaths from CVD (41.3%) than from the next seven causes of death combined, and the risk of dying from CVD is six-fold greater than that from breast cancer, the major concern among women. 1 There are sex-specific differences regarding CVD presentation, pathophysiology and clinical outcomes; however, as observed by Shivpuri S. et al. 2 , in a meta-analysis only 5 of 21 studies provided information specific to the female sex, and only a few reported sex-specific differences. 2-4 Recent data have shown a significant increase in the incidence of cardiovascular disease and deaths among women aged 45 to 54 years, in contrast to the declining trend observed in Brazil and worldwide. 2,5 According to the American Heart Association, women show a worse risk factor profile and higher mortality among the youngsters as compared to the elderly, in addition to high in-hospital, early and late mortality rates as compared to men. 2,6-11 There is growing evidence that psychological factors and emotional stress, such as anger and hostility, can interfere with health behaviors and influence the onset and clinical course of ischemic heart disease. 2 At the biological level, the expression of anger can lead to a chronic increase in the levels of catecholamines, evoking an inflammatory response, increasing interleukin-6 levels, 12 leading to the progression of atherosclerosis, and, eventually, to the clinical manifestation of cardiovascular diseases. 13-15 In a previous study, we have reported a significantly lower control of anger in patients with coronary artery disease (CAD), independently of the traditional risk factors, the occurrence of previous events or other aspects of anger. 16 This study aimed at assessing the association between anger and CAD, its clinical course and predictors of low anger control in women undergoing cine coronary angiography. Methods Patients This is a prospective cohort study. All women scheduled for elective coronary angiography because of suspected CAD during the study period were consecutively assessed. This study included women aged 18 years and older, who provided written informed consent to participate in the study. The exclusion criteria were: indication for catheterization for 410