Anger, denial, and cardiovascular reactivity in postmenopausal women

Abstract

Coronary heart disease (CHD) is the leading cause of death for women in the United States. The relationship between anger and cardiovascular reactivity, studied extensively in men, indicates that anger may be a contributing factor in the development of CHD. Only recently has research suggested that anger also may increase the risk of CHD in women. The purpose of this study was to examine the combined effects of anger and denial on cardiovascular responses to mental stressor tasks and CHD risk factors in postmenopausal women. Eighty postmenopausal women (58 +/- 5 years old, mean + SD) participated in the study. A median split on trait anger and denial was used to classify subjects into three groups: (1) low anger/low denial; (2) low anger/high denial; and (3) high anger/low or high denial. Mental stressors given to the women were speech and anger recall tasks. CHD risk factors included cholesterol (CHOL), triglycerides (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) body mass index (BMI), and waist-hip ratio (WHR) At baseline WHR (0.80 +/- 0.10), CHOL (201 +/- 33), TG (125 +/- 56), HDL-C (56 +/- 16), and LDL-C (119 +/- 31) were with in normal limits. BMI (29 +/- 8) indicated obesity. Repeated measures analysis of variance revealed statistically significant (P < .05) changes in heart rate and systolic and diastolic blood pressure from baseline to each stress task, however there were no significant differences between the groups. The speech task precipitated a greater heart rate change than the anger recall task. A significant change in both negative and positive affect accompanied the cardiovascular changes, but the groups did not differ on CHD risk factors. Anger and denial may be part of a complex pattern of psychological vulnerability to CHD risk and disease end-points. If cardiovascular reactivity is the mediating mechanism, then women may be at increased risk. Continued efforts toward refining the relationship of anger and denial and its biological impact will contribute to a better understanding of women's coronary-prone behavior association with CHD.