HOSTILITY AND INCREASED RISK OF MORTALITY AND ACUTE MYOCARDIAL-INFARCTION - THE MEDIATING ROLE OF BEHAVIORAL RISK-FACTORS

Cynical hostility has been associated with increased cardiovascular mo rbidity and mortality; yet few studies have investigated this relation in population-based samples, and little is known about underlying mec hanisms. This study examined the association between hostility, measur ed by the eight-item Cynical Distrust Scale, and risk for all-cause an d cardiovascular mortality and incident myocardial infarction. Subject s were 2,125 men, ages 42-60 years, from the Kuopio Ischemic Heart Dis ease Risk Factor Study, a longitudinal study of unestablished and trad itional risk factors for ischemic heart disease, mortality, and other outcomes. There were 177 deaths (73 cardiovascular) in 9 years of foll ow-up. Men with hostility scores in the top quartile were at more than twice the risk of all-cause mortality (relative hazards (RH) 2.30, 95 % confidence interval (CI) 1.47-3.59) and cardiovascular mortality (RH 2.70, 95% CI 1.27-5.76), relative to men with scores in the lowest qu artile. Among 1,599 men without previous myocardial infarction or angi na, high scorers also had an increased risk of myocardial infarction ( RH 2.18, 95% CI 1.01-4.70). Biologic and socioeconomic risk factors, s ocial support, and prevalent diseases had minimal impact on these asso ciations, whereas adjustments for the behavioral risk factors of smoki ng, alcohol consumption, physical activity, and body mass index substa ntially weakened the relations. Simultaneous risk factor adjustment el iminated the observed associations. Results show that high levels of h ostility are associated with increased risk of all-cause and cause-spe cific mortality and incident myocardial infarction and that these effe cts are mediated primarily through behavioral risk factors.