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We investigated whether frequency of strong anger is associated with the incidence of specific CVDs and CVD mortality, and if sex, age, and cardiometabolic risk factors modify these associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We used data from a population-based cohort of 47\u2009077 Swedish adults (56\u201394 years of age) who completed questionnaires regarding their experience of anger, lifestyle habits, and health characteristics. Participants were followed for incident cardiovascular outcomes and death up to 9 years through linkage to the Swedish National Patient and Death Registers. Hazard ratios and confidence intervals adjusted for potential confounders were assessed.<\/jats:p><jats:p>In multivariable analyses, frequent episodes of strong anger were associated with an increased risk of heart failure, atrial fibrillation, and CVD mortality [hazard ratios (95% confidence intervals)\u2009=\u20091.19 (1.04\u20131.37), 1.16 (1.06\u20131.28), and 1.23 (1.09\u20131.40), respectively]. The link between anger frequency and heart failure was more pronounced in men and participants with a history of diabetes. No evidence of an independent association of anger frequency with risk of myocardial infarction, aortic valve stenosis, and abdominal aortic aneurysm was found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings indicate that anger may contribute to the development of specific CVDs and CVD mortality, especially heart failure in men and in those with diabetes.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjopen\/oeac050","type":"journal-article","created":{"date-parts":[[2022,8,6]],"date-time":"2022-08-06T12:40:09Z","timestamp":1659789609000},"source":"Crossref","is-referenced-by-count":18,"title":["Anger frequency and risk of cardiovascular morbidity and mortality"],"prefix":"10.1093","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2747-1606","authenticated-orcid":false,"given":"Olga E","family":"Titova","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Baron","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden"},{"name":"Department of Medicine, University of North Carolina School of Medicine , Chapel Hill, NC , USA"},{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-1217","authenticated-orcid":false,"given":"Karl","family":"Micha\u00eblsson","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0118-0341","authenticated-orcid":false,"given":"Susanna C","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University , Uppsala , Sweden"},{"name":"Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,6]]},"reference":[{"key":"2022091413544549700_oeac050-B1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.amjcard.2016.05.041","article-title":"Meta-analysis of anxiety as a risk factor for cardiovascular disease","volume":"118","author":"Emdin","year":"2016","journal-title":"Am J Cardiol"},{"key":"2022091413544549700_oeac050-B2","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.1093\/eurheartj\/ehl338","article-title":"Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies","volume":"27","author":"Nicholson","year":"2006","journal-title":"Eur Heart J"},{"key":"2022091413544549700_oeac050-B3","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.ehj.2004.03.003","article-title":"Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men","volume":"25","author":"\u00d6hlin","year":"2004","journal-title":"Eur Heart J"},{"key":"2022091413544549700_oeac050-B4","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1093\/eurheartj\/ehu033","article-title":"Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis","volume":"35","author":"Mostofsky","year":"2014","journal-title":"Eur Heart J"},{"key":"2022091413544549700_oeac050-B5","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/PSY.0000000000000775","article-title":"Anger expression and the risk of cardiovascular disease among urban and rural Japanese residents: the circulatory risk in communities study","volume":"82","author":"Tezuka","year":"2020","journal-title":"Psychosom Med"},{"key":"2022091413544549700_oeac050-B6","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1161\/01.CIR.0000118535.15205.8F","article-title":"Anger and hostility predict the development of atrial fibrillation in men in the Framingham offspring study","volume":"109","author":"Eaker","year":"2004","journal-title":"Circulation"},{"key":"2022091413544549700_oeac050-B7","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1161\/01.CIR.94.9.2090","article-title":"A prospective study of anger and coronary heart disease. 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