{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T11:34:19Z","timestamp":1782214459442,"version":"3.54.5"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,9,26]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Hostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease (\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              ), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We prospectively examined the association between self\u2010reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              from the Heart and Soul Study. Baseline hostility was assessed using the 8\u2010item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow\u2010up time of 7.4\u00b12.7\u00a0years, the age\u2010adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age\u2010adjusted hazard ratio [\n              <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n              ]: 1.68, 95% confidence interval [\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              ]: 1.30 to 2.17;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). After adjustment for cardiovascular risk factors, participants with hostility scores in the highest quartile had a 58% greater risk of secondary events than those in the lowest quartile (\n              <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n              : 1.58, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              : 1.19 to 2.09;\n              <jats:italic>P<\/jats:italic>\n              =0.001). This association was mildly attenuated after adjustment for C\u2010reactive protein (\n              <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n              : 1.41, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.06 to 1.87;\n              <jats:italic>P<\/jats:italic>\n              =0.02) and no longer significant after further adjustment for smoking and physical inactivity (\n              <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n              : 1.25, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              : 0.94 to 1.67;\n              <jats:italic>P<\/jats:italic>\n              =0.13).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Hostility was a significant predictor of secondary events in this sample of outpatients with baseline stable\n              <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>\n              . Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.113.000052","type":"journal-article","created":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T07:32:47Z","timestamp":1380612767000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Hostility, Health Behaviors, and Risk of Recurrent Events in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study"],"prefix":"10.1161","volume":"2","author":[{"given":"Jonathan M.","family":"Wong","sequence":"first","affiliation":[{"name":"School of Medicine, University of California, Irvine, CA"},{"name":"Doris Duke Clinical Research Fellowship Program, University of California, San Francisco, 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