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Hostility linked with higher risk of death after second heart attacks

Secondary Prevention
Stress, Psycho-Social and Cultural Aspects of Heart Disease

Sophia Antipolis, 15 September 2020:  Heart attack patients who are sarcastic or irritable could be putting their health at risk, according to research published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).1

“Hostility is a personality trait that includes being sarcastic, cynical, resentful, impatient or irritable,” said study author Dr. Tracey Vitori of the University of Tennessee, Knoxville, US. “It’s not just a one-off occurrence but characterises how a person interacts with people. We know that taking control of lifestyle habits improves the outlook for heart attack patients and our study suggests that improving hostile behaviours could also be a positive move.”

This was one of the largest and most comprehensive studies examining the relationship between hostility and outcomes in heart attack patients. It was a secondary analysis of data from the PROMOTION trial.2

The study included 2,321 heart attack survivors. Hostility was measured at baseline using the Multiple Adjective Affect Checklist (MAACL). Patients were followed for 24 months for recurrent heart attacks and death.

The average age of participants was 67 years and 68% were men. More than half of the patients (57%) were scored as hostile according to the MAACL.

Hostility was an independent predictor of dying from a second heart attack after adjusting for other factors that could affect the relationship including sex, age, education, marital status, diabetes, high blood pressure, and smoking.

Dr. Vitori noted that hostility did not predict recurrent heart attacks. She said: “Hostility has been linked with cardiovascular disease since the 1950s, but we still don’t fully understand why. Our study shows that hostility is a common trait in heart attack survivors and is associated with poor outcomes. More research is needed on how this characteristic affects the body.”

The paper states that anxiety and depression are emotional states typically evaluated in patients with heart disease. Adding an assessment of hostility may identify patients at risk for premature death. Educating patients on the potential impact of hostility could motivate behavioural changes.

Dr. Vitori said: “There is much cardiac patients can do to take control of their own health. From a physical side – smoking cessation, increase physical activity, and eat a balanced diet. Our study also indicates that managing hostile behaviours could be important.”



Notes to editor

Authors: ESC Press Office


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Funding: This work was supported by National Institute of Health/National Institute of Nursing Research (NIH R01 # R01 NR007952).

Disclosures: None.


1Vitori TA, Frazier SK, Biddle MJ, et al. Hostility predicts mortality but not recurrent acute coronary syndrome. Eur J Cardiovasc Nurs. 2020. doi:10.1177/1474515120950913.

2Dracup K, McKinley S, Riegel B, et al. A randomized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome. Circ Cardiovasc Qual Outcomes. 2009;2:524–532.


About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About the European Journal of Cardiovascular Nursing

The European Journal of Cardiovascular Nursing is the international journal of the European Society of Cardiology dedicated to the advancement of knowledge in the field of cardiovascular nursing and the promotion of evidence-based clinical practice.