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 that emotional discomfort and symptoms were positively associated with higher inward expression of anger and lower control of anger. In addition, they have found that preventive practices were associated with lower supression and higher control of anger, with better channeling and regulation of anger feelings. The likelihood that patients with low anger control also have low control over other risk behaviors or use them as a comfort mechanism can be considered, because the effects of well-being through neuroendocrine mechanisms of hormone release, such as serotonin, producing well-being after energetic ingestion, have been described, which would be applicable to stress/anger situations. 27 The compensation, cognitive and affective value attributed to food overlaps the homeostatic control and the physiological signs of hunger and satiety that control food ingestion and body weight. 27,28 However, if continuously evoked, that process would cause CAD as a factor associated not only with the feeling of anger, but with all the inappropriate coping mechanism that could accompany anger. Study’s forces and limitations This study’s force resides on its female sample, because women are usually under-represented in clinical trials. This is a segment of the real world, with few losses during a long follow‑up. The risk factors were assessed based on interviews with the participants, and there might have been bias of information. Assessing anger and its control, even with a tool developed for that purpose, is a hard task, considering that personality traits can be combined. Research in this area is a challenge. Conclusions Women with CAD submitted to coronary angiography showed a trend towards lower control of anger, which was associated with age and the family history of CAD. The 48-month clinical follow-up showed no significant difference in the event-free time between patients with anger control scores above average range and those with anger control scores below it. Author contributions Conception and design of the research: Moura MR, Gottschall CAM, Schmidt MM; Acquisition of data: Schmidt KES, Schmidt MM; Analysis and interpretation of the data: Schmidt KES, Quadros AS, Moura MR, Gottschall CAM, Schmidt MM; Statistical analysis: Schmidt MM; Writing of the manuscript: Schmidt KES, Quadros AS, Schmidt MM; Critical revision of the manuscript for intellectual content: Quadros AS, Moura MR, Gottschall CAM. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This article is part of the thesis of Doctoral submitted by Márcia Moura Schmidt, from Instituto de Cardiologia / Fundação Universitária de Cardiologia. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Instituto de Cardiologia / Fundação Universitária de Cardiologia under the protocol number 466/12. 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