ABC | Volume 111, Nº3, September 2018

Original Article Schmidt et al Anger and coronary artery disease in women Arq Bras Cardiol. 2018; 111(3):410-416 Figure 1 – Survival curve for major cardiovascular events in up to 48 months of follow-up of women with anger control below and above average. 1.0 0.9 0.8 0.7 0.6 0.5 5 .00 10.00 15.00 20.00 25.00 35.00 40.00 50.00 45.00 30.00 CumSurvival p = 0.62 anger control: average < 27 ≥ 27 Time until 1 st end-point The survival curves separate between 5 and 20 months of follow-up and approximate after 30 months of follow-up. showing that patients whose anger control was below average had survival around 60%. while those whose anger control was above average had survival around 65%. (p = 0.62) Survival curve according to anger control Table 4 – Association between control of anger and baseline characteristics Characteristics Beta Coefficient 95% CI for Beta Coefficient p* Age 0.15 0.002 - 0.013 0.01 Family history of CAD 0.22 0.100 - 0.340 < 0.001 Diabetes mellitus 0.007 - 0.039 - 0.170 0.21 Previous CABG - 0.06 - 0.480 - 0.140 0.27 p * - p ≤ 0.05, Wald test; CI: confidence interval; CAD: coronary artery disease; CABG: coronary artery bypass grafting. In this sample, the women with low anger control were younger. That characteristic can be interpreted in the sense that, as age advances, social relations are modulated through emotional regulation, which means that, as time advances and with aging, more appropriate forms of social behavior are learned, with more control over emotions and reactions. 21 According to Cartensen’s socioemotional selectivity theory, as age advances, people become increasingly selective, tending to place a high value on positive contents and to avoid negative emotional states, because of adaptation and life changes experienced in social contexts. 22,23 According to Shirato et al., 24 gender differences are evident in the success rates of the interventions to improve coronary circulation (myocardial revascularization). After a well‑succeeded procedure, women submitted to coronary angioplasty had an excellent prognosis in the long run, similar to that observed in men. However, complications related to PCI and the mortality rates of women are three times higher as compared to those of men. 24 Haukalla et al. 20 have reported that low anger control in a 10- to 15-year clinical follow-up predicted ischemic myocardial disease in women, even after adjusting for sociodemographic variables, other cardiovascular risk factors and symptoms of depression. In the late clinical follow-up of this study, low control of anger was not associated with the occurrence of combined MCVE, myocardial revascularization included. The literature available shows that anger is associated with several behavioral risk factors, such as tobacco use and inadequate dietary intake (hypercaloric and high sodium diets), and, in the long run, out of other cardiovascular risk factors, anger can cause LDL elevation, hypertension, diabetes mellitus, and obesity. 13,25 In a study, Pérez-García et al. 26 have reported 414