Anger/Hostility and Depression Associated With An Inflammatory Marker of Cardiovascular Disease In African Americans

Denee T. Mwendwa, PhD 1 , Joneis Thomas, PhD 1 , Stacey Crump, MS 1 , Debra L. Morehead, BA 1 , Jessica Wiley, BS 1 , Janeese Brownlow, MS 1 , Clive O. Callender, MD 2 , Alfonso Campbell, Jr., PhD 1 Howard University 1 and Howard University Hospital 2 , Washington, DC 20059

Background

 Cardiovascular disease is the leading cause of death among individuals with high levels of C-reactive protein (CRP), a biomarker of inflammation (Harris, et al., 1999).

 Studies have reported significant associations between CRP, a biomarker of inflammation, and anger (Suarez, 2004), hostility (Graham, et al., 2002; Suarez, 2003a), and depressive symptoms (Miller, et al., 2002; Suarez, et al., 2003).

 A study investigating risk factors for cardiovascular disease, utilizing a cohort of apparently healthy men and women, reported that greater anger and severity of depressive symptoms, separately and in combination with hostility, were found to be significantly associated with elevations of CRP (Suarez, 2004).

Purpose and Hypothesis

 Purpose: The purpose of this study was to investigate the relationship between and the predictive value of anger/ hostility and depressive symptoms on C-reactive protein.

 Hypothesis : Both “trait” anger/hostility and “trait” depression will significantly correlate with and be predictive of CRP levels in this community-based sample of African Americans.

Methods

 Participants: African Americans (N=199), males (n=93 or 48.4%) and females (n=106 or 51.6%), 21 to 73 years of age, residing in Washington, DC, Maryland, or Virginia were the participants in this study. All participants were treated as genetically unrelated. Participant recruitment was through conventional means.

ANGER/ H O S T I L I T Y

 Setting : Howard University Hospital’s General Clinical Research Center (GCRC) located in Washington, DC.

 Tests and Measures: Following the signing of a consent form and completion of a health screening, participants were administered a battery of neurocognitive and psychosocial tests, along with anthropometric and other measures. For this study, only data collected from the NEO Personality Inventory-Revised (NEO-PI-R), Cook-Medley Hostility Scale, and a blood draw for measuring serum C-reactive protein (CRP) levels, were analyzed and reported. The NEO-PI R assesses “trait” personality and is identified by those individuals who are prone to psychological distress (Costa & McCrae, 1992). The Cook Medley Scale (CMS) assesses “trait” tendencies towards cynical attitudes, aggression, and anger responses (Cook & Medley, 1954). ELISA assay procedures were conducted for serum CRP.

Sample Characteristics C

(N=199) Age (yrs.) Men Women Body Mass Index (kg/m²) Systolic BP (mm Hg) Diastolic BP (mm Hg) NEO-PI-R Anger/Hostility Ho Anger/Hostility NEO-PI-R Depression C-reactive Protein a 45.60 + 11.6

93 (48.4% 106 (51.6%) 31 + 9 133 + 18 79 + 13 50 + 5 23.3 + 7.8

50 + 5 1.8 (.80-4.20) a Median and interquartile range.

Values are expressed as mean + SD or number (%).

R p D E P R E S S I O N Results

Adjusted and Unadjusted Correlations Between Log-normalized C-reactive Protein and Psychological Measures NEO-PI-R Anger/Hostility CMS Anger/Hostility NEO-PI-R Depression Log-normalized CRP Unadjusted Adjusted (Age, BMI, Diabetes, Hypertension) .122* .197** .145* .029

.213** .110

*p ≤0.05; **p≤0.01

Variables CMS Anger/Hostility NEO Anger/Hostility NEO Depression

Regression Analyses

ß .226

.030

.074

*Dependent Variable: C-reactive Protein

R ² .051

Sig.

.003

.725

.378

Discussion

 Bivariate analyses revealed that both “trait” anger/hostility, unadjusted, (NEO-PI-R, r=.122, p ≤0.05; Ho, r=.197, p≤0.01) and “trait” depression (NEO-PI-R, r=.145, p≤0.05) were significantly linked to log normalized CRP.  After adjusting for age, BMI, diabetes, and hypertension, the CMS’s anger/hostility remained significant with log normalized CRP.

 In stepwise multiple regression analyses, the CMS’s anger/hostility emerged as the only predictor of CRP levels ( ß=.226, p=.003), accounting for 5.1% of the variance in CRP.

Conclusion

 Negative mood states, such as anger/hostility and depression, give rise to acute phase systemic immune system responses that may lead to cardiovascular risk and disease.

Implications

 Inquire about mood states shown to be related to cardiovascular disease.

 Make appropriate referrals as necessary.

 Consider an on-site Clinical Psychologist to provide consultation liaison services.

Acknowledgement

This research is part of a larger study entitled “Stress and Psychoimmunological Factors in Renal Health and Disease” that is funded by The National Center on Minority Health and Health Disparities, under Grant #1P20MD000512-04 titled “A Research Center to Reduce Ethnic Disparities in ESRD”.