Hostility Predicts Mortality But Not Recurrent Acute Coronary Syndrome

Background: Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical. Aims: The aim of our study was to determine whether hostility was a predictor of ACS recurrence and mortality. Methods: We performed a secondary analysis of data (N= 2321) from a large randomized clinical trial of an intervention designed to reduce pre-hospital delay among patients who were experiencing ACS. Hostility was measured at baseline with the Multiple Adjective Affect Checklist (MAACL) and patients were followed for 24 months for evaluation of ACS recurrence and all-cause mortality. We used Cox proportional hazards modeling to determine whether hostility was predictive of time to ACS recurrence or all-cause mortality. Results: The majority of patients were married (73%), Caucasian (97%), men (68%), and had a mean age of 67 +/- 11 years. Fifty-seven percent of participants scored as hostile based on the established MAACL cut point (mean score = 7.56 +/- 3.8). Hostility was an independent predictor of all-cause mortality (p= < 0.039), but was not a predictor of ACS recurrence (p= 0.792). Conclusion: Hostility is common in patients with ACS and its relationship to clinical outcomes is important to the design of future interventions to improve long-term ACS mortality.