Anger expression and incident stroke - Prospective evidence from the Kuopio Ischemic Heart Disease Study

Background and Purpose-High levels of anger are associated with an increase d risk of coronary heart disease and hypertension, but little is known abou t the role of anger in stroke risk. Methods-Anger expression style and risk of incident stroke were examined in 2074 men (mean age, 53.0 +/- 5.2 years) from a population-based, longitudi nal study of risk factors for ischemic heart disease and related outcomes i n eastern Finland. Self-reported style of anger expression was assessed by questionnaire at baseline. Linkage to the FINMONICA stroke and national hos pital discharge registers identified 64 first strokes (50 ischemic) through 1996. Average follow-up time was 8.3+/-0.9 (mean+/-SD) years. Results-Men who reported the highest level of expressed anger were at twice the risk of stroke (relative hazard, 2.03; 95% CI, 1.05 to 3.94) of men wh o reported the lowest level of anger, after adjustments for age, resting bl ood pressure, smoking, alcohol consumption, body mass index, low-density an d high-density lipoprotein cholesterol, fibrinogen, socioeconomic status, h istory of diabetes, and use of antihypertensive medications. Additional ana lysis showed that these associations were evident only in men with a histor y of ischemic heart disease (n=481), among whom high levels of outwardly ex pressed anger (high anger-out) predicted >6-fold increased risk of stroke a fter risk factor adjustment (relative hazard, 6.87; 95% CI, 1.50 to 31.4). Suppressed anger (anger-in) and controlled anger (anger-control) were not c onsistently related to stroke risk. Conclusions-This is the first population-based study to show a significant relationship between high levels of expressed anger and incident stroke. Ad ditional research is necessary to explore the mechanisms that underlie this association.