Hostility Threatens Young Hearts

Hostility may be bad for your heart, especially if you are a young heart disease patient.

Hostility is higher in younger heart disease patients compared with older people with the same condition, according to a new study.

In addition, hostility can make heart symptoms worse in young patients. Evidence shows young heart disease patients have poorer long-term prognosis, and that hostility is associated with premature heart disease and heart attacks, write researchers.

Those with “high hostility have a significantly worse [heart disease risk] profile” than patients of the same age who aren’t hostile, says Carl Lavie, MD, a cardiologist who worked on the study.

“Clinicians need to recognize that psychological factors are important; they can’t be basically blown off,” he tells WebMD.

Exercise and cardiac rehabilitation can help patients defuse hostility while also helping their overall health, says Lavie, who works at the Ochsner Clinic Foundation in New Orleans.

“Cardiac rehabilitation and an exercise training program have a significant impact to reduce hostility while improving many other [risk factors],” he tells WebMD.

Psychology Meets Cardiology

The idea that psychological factors — such as hostility and depression — can influence heart health isn’t new. But it’s important and often overlooked, says Lavie.

“Psychological factors have not been emphasized,” he tells WebMD, adding that most studies have focused on the high rates of depression in heart disease patients.

Studying the Hostile Heart

Lavie and co-worker Richard Milani, MD, recently studied hostility and heart disease in 500 patients at the Ochsner Clinic Foundation. The patients had enrolled in a cardiac rehabilitation program two to six weeks after having survived a heart attack or after undergoing a surgical procedure to unblock clogged atherosclerotic vessels of the heart.

Participants were divided into three age groups: young (under age 50), middle age (50-65 years), and elderly (65 or older). Data included cholesterol and blood sugar levels, as well as questionnaires covering hostility and quality of life.

Hostility scores were 2.5 times higher in the 81 patients who were younger than 50 years old, compared with the 268 elderly patients, the study shows.

At the study’s start, the hostile young patients were in poorer shape than their peers who weren’t hostile. Their scores were worse from every angle, from cholesterol to blood sugar to quality of life.

Rehab, Exercise Helped

Taking a 12-week cardiac rehabilitation course and exercise program helped all of the participants.

They got 36 exercise and education sessions, where they learned about heart health. Researchers also encouraged participants to exercise on their own a couple of times a week, but that wasn’t monitored.

Their supervised exercise sessions started with a 10-minute warm-up, followed by 30-45 minutes of aerobic exercise, such as walking, jogging, rowing, riding a stationary bike, or using light weights. After that, they cooled down for 10 minutes by doing calisthenics and stretching.

Obesity, cholesterol, and aerobic capacity all improved. But that wasn’t all. Mental and emotional health also fared better after the program.

Less Hostility, Better Health

Anxiety fell by 43 percent, depression dropped 59 percent, and hostility decreased by 44 percent, the study shows. In fact, after cardiac rehabilitation, 12 out the 23 young hostile patients were no longer hostile. Among the young patients, the rates of hostility symptoms decreased by 50 percent after cardiac rehabilitation.

Compared with their mellower peers, the young patients who had been hostile had “significantly greater improvements in total cholesterol levels, hostility scores, and quality of life,” say researchers.

The cardiac program touched on psychological issues, but that wasn’t its main point. No one got psychotherapy as part of the program, says Lavie.

It’s possible that the patients’ hostility started after their heart problems began, but “we don’t think that’s the case,” says Lavie. He also notes that many patients don’t go for cardiac rehab, so the participants in his study might not be representative of the general population.

Still, the finding “further supports the benefits of exercise,” Lavie tells WebMD. Exercise can help blow off steam. Many studies have shown that hostility and unexpressed anger are risk factors for heart disease, but that’s just the tip of the iceberg. “There are probably many things that exercise training is doing,” says Lavie.

The study appears in the March issue of Mayo Clinic Proceedings.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Lavie, C. Mayo Clinic Proceedings, March 2005; vol 80: pp 335-342. Carl Lavie, MD, Ochsner Clinic Foundation, New Orleans. News release, Ochsner Clinic Foundation.