Anger a risk factor for stroke among the young and those with high HDL levels

By Martha Kerr

NEW YORK (Reuters Health) – People with high trait anger who are younger than 60 or have HDL cholesterol levels greater than 47 mg/dL have nearly three times the risk of ischemic stroke than their counterparts with low trait anger.

The findings come from a subanalysis of the Atherosclerosis Risk in Communities Study (ARIC) data, and are published in the January issue of Stroke: Journal of the American Heart Association. The study sample included 13,851 black and white men and women between 48 and 67 years of age who completed the Spielberger Trait Anger Scale. ARIC investigators, led by Dr. Janice E. Williams, of the Centers for Disease Control and Prevention in Atlanta, followed the subjects for a median of 77.3 months.

For the entire group, subjects who scored as having high levels of trait anger had only a "modest" increase in risk of stroke. However, when broken down by age, Dr. Williams and colleagues found that those less than 60 years of age had 2.82 times the risk of all strokes and 2.93 times the risk of ischemic strokes than those with low trait anger.

"The findings regarding the influence of age are consistent with those from previous studies in which a positive association has been observed between anger/hostility and coronary artery disease in younger but not older persons. It is possible that older persons with high trait anger were spared because they were hardier constitutionally," Dr. Williams told Reuters Health. "Alternatively, since older age alone is associated with increased risk for stroke, the addition of an anger-prone personality may have conferred little additional risk."

When the data were analyzed according to HDL cholesterol levels above or below the median of 47 mmol/L, the risk of any stroke for those with high levels was 2.86 times higher, and the risk of ischemic stroke was 2.98 times higher for those with high anger scores and.

Dr. Williams noted that stroke risk is usually associated with low HDL levels. Similar to the effect of age, the contribution of trait anger to stroke risk might be apparent only in those with high HDL levels, she suggested.

"Though we've not tested this hypothesis directly, evidence from ARIC and other studies suggest that anger may exert its greatest influence on cardiovascular disease in persons who otherwise are at low (versus high) risk for the disease," Dr. Williams concluded.

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