Abstract
BACKGROUND: Trait anger, hostility, and serum level of homocysteine are associated with recurrent cardiac events after percutaneous coronary interventions. However, whether trait anger or hostility influences the association between serum level of homocysteine and recurrent cardiac events is unknown. OBJECTIVES: To examine the relationships among trait anger, hostility, serum level of homocysteine, and recurrent cardiac events after percutaneous coronary interventions. METHODS: This prospective study included 135 consecutive patients (68% male, mean age 61 [SD, 10] years) undergoing percutaneous coronary interventions during an index hospitalization. Trait anger and hostility were measured with the Spielberger Trait Anger Scale and the Cynical Hostility Scale, respectively. Blood samples were obtained to measure serum levels of total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, and homocysteine. Recurrent cardiac events (emergency department visits and rehospitalization) were noted for 6 months after discharge and confirmed by review of hospital records. Hierarchical Cox hazard regression was used for statistical analysis. RESULTS: Trait anger (hazard ratio = 1.11, 95% confidence interval = 1.03-1.20) and homocysteine level (hazard ratio = 1.10, 95% confidence interval = 1.01-1.21) were independent predictors of recurrent cardiac events after other risk factors were controlled for. Patients with high trait anger (score > or = 24) and high serum level of homocysteine (> or = 11.3 mumol/L) had the shortest time to recurrent cardiac events (P = .01). CONCLUSION: Trait anger had a combined effect on the link between serum level of homocysteine and recurrent cardiac events. Interventions to reduce trait anger may improve health outcomes by influencing both trait anger and homocysteine level.