The DOI matches its Crossref record; 71 of the 71 references it cites were found in a registry or an index.
Hostility and Increased Risk of Mortality and Acute Myocardial Infarction: The Mediating Role of Behavioral Risk Factors
Abstract
Cynical hostility has been associated with increased cardiovascular morbidity and mortality; yet few studies have investigated this relation in population-based samples, and little is known about underlying mechanisms. This study examined the association between hostility, measured by the eight-item Cynical Distrust Scale, and risk for all-cause and cardiovascular mortality and incident myocardial infarction. Subjects were 2,125 men, ages 42-60 years, from the Kuopio Ischemic Heart Disease Risk Factor Study, a longitudinal study of unestablished and traditional risk factors for ischemic heart disease, mortality, and other outcomes. There were 177 deaths (73 cardiovascular) in 9 years of follow-up. Men with hostility scores in the top quartile were at more than twice the risk of all-cause mortality (relative hazards (RH) 2.30, 95% confidence interval (CI) 1.47-3.59) and cardiovascular mortality (RH 2.70, 95% CI 1.27-5.76), relative to men with scores in the lowest quartile. Among 1,599 men without previous myocardial infarction or angina, high scorers also had an increased risk of myocardial infarction (RH 2.18, 95% CI 1.01-4.70). Biologic and socioeconomic risk factors, social support, and prevalent diseases had minimal impact on these associations, whereas adjustments for the behavioral risk factors of smoking, alcohol consumption, physical activity, and body mass index substantially weakened the relations. Simultaneous risk factor adjustment eliminated the observed associations. Results show that high levels of hostility are associated with increased risk of all-cause and cause-specific mortality and incident myocardial infarction and that these effects are mediated primarily through behavioral risk factors.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“and all-cause and CVD mortality in other large cohorts [117, 177, 178].”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [177]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Cox, D. R., & Oakes, D. (2018) · Chapman & Hall/CRC eBooks · doi:10.1201/9781315137438 · Cited by 6,269
Healthy People 2000: National Health Promotion and Disease Prevention Objectives.
Heidel, R. E. (1991) · Population and Development Review · doi:10.2307/1971966 · Cited by 3,162
Cardiovascular Survey Methods.
Rose, G., & Blackburn, H. (1968) · Annals of Internal Medicine · doi:10.7326/0003-4819-69-6-1335_2 · Cited by 3,090
Socioeconomic factors and cardiovascular disease: a review of the literature.
Kaplan, G. A., & Keil, J. E. (1993) · Circulation · doi:10.1161/01.cir.88.4.1973 · Cited by 1,845
Self-citationProposed hostility and Pharisaic-virtue scales for the MMPI.
Cook, W. W., & Medley, D. M. (1954) · Journal of Applied Psychology · doi:10.1037/h0060667 · Cited by 1,483
Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease.
(1980) · Annals of Internal Medicine · doi:10.7326/0003-4819-93-5-786_2 · Cited by 1,426
The Epidemiology of Social Stress
Turner, R. J., Wheaton, B., & Lloyd, D. A. (1995) · American Sociological Review · doi:10.2307/2096348 · Cited by 1,362
Lynch, J. W., Kaplan, G. A., & Salonen, J. T. (1997) · Social Science & Medicine · doi:10.1016/s0277-9536(96)00191-8 · Cited by 1,150
Self-citationHostility, CHD Incidence, and Total Mortality: A 25-Year Follow-Up Study of 255 Physicians
Barefoot, J. C., Dahlstrom, G. W., & Williams, R. B. (1983) · Psychosomatic Medicine · doi:10.1097/00006842-198303000-00008 · Cited by 866 · cited 2×
“, (11-13)), hostility as measured by the Cook-Medley Hostility Scale, its item subsets and related scales, has been associated with a number of cardiovascular outcomes as well as all-cause and noncardiovascular mortality in clinical and population samples (7-9, 41, 62) and indeed, with both mortality and incidence in…”
BackgroundMethodHostility and health: Current status of a psychosomatic hypothesis.
Smith, T. W. (1992) · Health Psychology · doi:10.1037//0278-6133.11.3.139 · Cited by 729
Sullivan, L. W. (1990) · New England Journal of Medicine · doi:10.1056/nejm199010113231511 · Cited by 701
Social class and coronary heart disease.
Rose, G., & Marmot, M. G. (1981) · Heart · doi:10.1136/hrt.45.1.13 · Cited by 644
Type A Behavior, Hostility, and Coronary Atherosclerosis*
Williams, R. B., Haney, T. L., Lee, K. L., Kong, Y., Blumenthal, J. A., & Whalen, R. E. (1980) · Psychosomatic Medicine · doi:10.1097/00006842-198011000-00002 · Cited by 592
Components of Type A, Hostility, and Anger-In: Relationship to Angiographic Findings
Dembroski, T. M., MacDougall, J. M., Williams, R. B., Haney, T. L., & Blumenthal, J. A. (1985) · Psychosomatic Medicine · doi:10.1097/00006842-198505000-00001 · Cited by 431
Smith, T. W., & Frohm, K. D. (1985) · Health Psychology · doi:10.1037//0278-6133.4.6.503 · Cited by 385
Dembroski, T. M., MacDougall, J. M., Costa, P. T., & Grandits, G. A. (1989) · Psychosomatic Medicine · doi:10.1097/00006842-198909000-00003 · Cited by 377 · cited 2×
“More recently, attempts to isolate the important or "toxic" component of the broadly defined Type A behavior pattern, previously accepted as a risk factor for coronary heart disease (4), have focused on hostility (5, 6).”
BackgroundThe shape of the relationship between income and mortality in the United States
Backlund, E., Sorlie, P. D., & Johnson, N. J. (1996) · Annals of Epidemiology · doi:10.1016/1047-2797(95)00090-9 · Cited by 365
Type a Behavior and Mortality from Coronary Heart Disease
Ragland, D. R., & Brand, R. (1988) · New England Journal of Medicine · doi:10.1056/nejm198801143180201 · Cited by 358
SALONEN, J. T. (1988) · PubMed · Cited by 347
Self-citationPhysical Activity Behaviors in Lower and Higher Socioeconomic Status Populations
Ford, E. S., Merritt, R. K., Heath, G. W., Powell, K. E., Washburn, R. A., Kriska, A. M., & Haile, G. T. (1991) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115836 · Cited by 336
The role of anger and hostility in essential hypertension and coronary heart disease.
Diamond, E. L. (1982) · Psychological Bulletin · doi:10.1037/0033-2909.92.2.410 · Cited by 315
TYPE A BEHAVIOR PATTERN AND CORONARY DISEASE RISK UPDATE AND CRITICAL EVALUATION
Matthews, K. A., & HAYNES, S. C. (1986) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114347 · Cited by 315
Barefoot, J. C., Larsen, S., von der Lieth, L., & Schroll, M. (1995) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117663 · Cited by 285 · cited 3×
“(9) found that high scores on an abbreviated version of the Cook-Medley Hostility Scale were associated with an increased risk of myocardial infarction and all-cause mortality after 27 years of follow-up in the Glostrup (Denmark) study, which included more than 300 women.”
BackgroundMethodTHE MRFIT BEHAVIOR PATTERN STUDY
Shekelle, R. B., Hulley, S. B., Neaton, J. D., Billings, J. H., Borhani, N. O., Gerace, T. A., Jacobs, D. R., Lasser, N. L., Mittlemark, M. B., & Stamler, J. (1985) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114135 · Cited by 285
Situational determinants of cardiovascular and emotional reactivity in high and low hostile men.
Suarez, E. C., & Williams, R. B. (1989) · Psychosomatic Medicine · doi:10.1097/00006842-198907000-00004 · Cited by 280
Pathways to Health: The Role of Social Factors.
Rosenberg, T. J., Bunker, J. P., Gomby, D. S., & Kehrer, B. H. (1991) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2072131 · Cited by 274
Hostility during Late Adolescence Predicts Coronary Risk Factors at Mid-Life
Siegler, I. C., Peterson, B. L., Barfoot, J. C., & Williams, R. B. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116481 · Cited by 271
Barefoot, J. C., Peterson, B. L., Dahlstrom, W. G., Siegler, I. C., Anderson, N. B., & Williams, R. B. (1991) · Health Psychology · doi:10.1037//0278-6133.10.1.18 · Cited by 256
Hostility as a risk factor for mortality and ischemic heart disease in men.
Koskenvuo, M., Kaprio, J., Rose, R. J., Kesäniemi, A., Sarna, S., Heikkilä, K., & Langinvainio, H. (1988) · Psychosomatic Medicine · doi:10.1097/00006842-198807000-00002 · Cited by 232 · cited 2×
“Several studies have documented an association between high CookMedley Hostility Scale scores and greater alcohol and tobacco use, less leisure-time activity, greater caloric intake, and higher body mass index (BMI) (10, 2527).”
BackgroundHostility and Health Behaviors in Young Adults: The CARDIA Study
Scherwitz, L. W., Perkins, L. L., Chesrtey, M. A., Hughes, G. H., Sidney, S. S., & Manolio, T. A. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116480 · Cited by 222
Neuroticism and cynicism and risk of death in middle-aged men: the Western Electric Study.
Almada, S. J., Zonderman, A. B., Shekelle, R. B., Dyer, A. R., Daviglus, M. L., Costa, P. T., & Stamler, J. (1991) · Psychosomatic Medicine · doi:10.1097/00006842-199103000-00006 · Cited by 208
Type A behavior pattern and coronary atherosclerosis.
Blumenthal, J. A., Williams, R. B., Kong, Y., et al. (1978) · Circulation · doi:10.1161/01.cir.58.4.634 · Cited by 206
Hearn, M. D., Murray, D. M., & Luepker, R. V. (1989) · Journal of Behavioral Medicine · doi:10.1007/bf00846545 · Cited by 196
Coronary-prone behaviors in the Western Collaborative Group Study.
Hecker, M. H. L., Chesney, M. A., Black, G. W., & Frautschi, N. M. (1988) · Psychosomatic Medicine · doi:10.1097/00006842-198803000-00005 · Cited by 194
Barefoot, J. C., Peterson, B. L., Dahlstrom, W. G., et al. (1991) · Health Psychology · doi:10.1037/0278-6133.10.1.18 · Cited by 192
Hostility and the progression of carotid atherosclerosis.
Julkunen, J., Salonen, R. M., Kaplan, G. A., Chesney, M. A., & Salonen, J. T. (1994) · Psychosomatic Medicine · doi:10.1097/00006842-199411000-00007 · Cited by 189
Self-citationHardy, J. D., & Smith, T. W. (1988) · Health Psychology · doi:10.1037/0278-6133.7.5.447 · Cited by 187
Neurogenic Factors in Pathogenesis of Coronary Heart Disease
Rosenman, R. H., & Friedman, M. (1974) · Medical Clinics of North America · doi:10.1016/s0025-7125(16)32158-7 · Cited by 186
Cynical hostility at home and work: Psychosocial vulnerability across domains
Smith, T. W., Pope, M. K., Sanders, J. D., Allred, K. D., & O'Keeffe, J. L. (1988) · Journal of Research in Personality · doi:10.1016/0092-6566(88)90008-6 · Cited by 185
Engebretson, T. O., Matthews, K. A., & Scheier, M. F. (1989) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.57.3.513 · Cited by 179 · cited 1×
“Other biologic factors, such as blood pressure or lipid levels, both of which have been related to hostility and the related construct of suppressed anger (33-36), also may play a role in the adverse effects of hostility on health.”
BackgroundEngebretson, T. O., Matthews, K. A., & Scheier, M. F. (1989) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.57.3.513 · Cited by 170
Construct validity and sex differences in Cook-Medley hostility
Greenglass, E. R., & Julkunen, J. (1989) · Personality and Individual Differences · doi:10.1016/0191-8869(89)90206-7 · Cited by 164
Self-citationScherwitz, L. W., Perkins, L., Chesney, M. A., & Hughes, G. (1991) · Psychosomatic Medicine · doi:10.1097/00006842-199101000-00004 · Cited by 158
Socioeconomic Status and Health: Old Observations and New Thoughts
Haan, M. N., Kaplan, G. A., & Syme, S. L. (1989) · Cited by 146
Self-citationWhere Do Shared Pathways Lead? Some Reflections on a Research Agenda
Kaplan, G. A. (1995) · Psychosomatic Medicine · doi:10.1097/00006842-199505000-00002 · Cited by 126
Self-citationStungo, E. (1951) · BMJ · doi:10.1136/bmj.2.4744.1405-b · Cited by 123
Williams, R. B., Barefoot, J. C., Haney, T. L., Harrell, F. E., Blumenthal, J. A., Pryor, D. B., & Peterson, B. (1988) · Psychosomatic Medicine · doi:10.1097/00006842-198803000-00004 · Cited by 121
A Link between Hostility and Disease: Poor Health Habits?
Leiker, M., & Hailey, B. J. (1988) · Behavioral Medicine · doi:10.1080/08964289.1988.9935136 · Cited by 120
Leon, G. R., Finn, S. E., Murray, D. M., & Bailey, J. M. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.56.4.597 · Cited by 116
Kaplan, G. A., Wilson, T. W., Cohen, R. D., Kauhanen, J., Wu, M., & SALONEN, J. T. (1994) · PubMed · Cited by 110
Self-citationTUOMILEHTO, J., Arstila, M., Kaarsalo, E., KANKAANPüÄ, J., Ketonen, M., Kuulasmaa, K., Lehto, S., Miettinen, H., Mustaniemi, H., Palomäki, P., et al. (1992) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a060219 · Cited by 104
Self-citationIn Search of Coronary-prone Behavior
(2013) · Psychology Press eBooks · doi:10.4324/9780203771679 · Cited by 102
TUOMILETHTO, J., Arstila, M., Kaarsalo, E., Kankaanpää, J., Ketonen, M., Kuulasmaa, K., Lehto, S., Miettinen, H., Mustaniemi, H., Palomäki, P., et al. (1992) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a060329 · Cited by 97
Educational Attainment and Coronary Heart Disease Risk: The Framingham Offspring Study
Garrison, R. J., Gold, R. S., Wilson, P. W. F., et al. (1993) · Preventive Medicine · doi:10.1006/pmed.1993.1004 · Cited by 90
Hostility and Coronary Artery Disease
Helmer, D. C., Ragland, D. R., & Syme, S. L. (1991) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115850 · Cited by 89
Lundberg, U., Hedman, M., Melin, B., et al. (1989) · Psychosomatic Medicine · doi:10.1097/00006842-198903000-00001 · Cited by 84
Psychoanalytic observations in cardiac disorders
Menninger, K. A., & Menninger, W. C. (1936) · American Heart Journal · doi:10.1016/s0002-8703(36)90371-x · Cited by 79
Houston, B. K., & Kelly, K. E. (1989) · Personality and Social Psychology Bulletin · doi:10.1177/0146167289152004 · Cited by 69
Cook-Medley Hostility, Anger, and the Type a Behavior Pattern in Finland
Greenglass, E. R., & Julkunen, J. (1991) · Psychological Reports · doi:10.2466/pr0.1991.68.3c.1059 · Cited by 62
Self-citationHostility-related variables and plasma lipid levels
Dujovne, V. F., & Houston, B. K. (1991) · Journal of Behavioral Medicine · doi:10.1007/bf00867170 · Cited by 61
Effect of trait hostility on cardiovascular responses to harassment in young men
Everson‐Rose, S. A., McKey, B. S., & Lovallo, W. R. (1995) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm0202_6 · Cited by 53
Personality, Elevated Blood Pressure, and Essential Hypertension
Johnson, E. H., Gentry, W. D., & Julius, S. (2026) · Routledge eBooks · doi:10.4324/9781042029280 · Cited by 34
Psychosocial predictors of hypertension in Black and White Africans
Somova, L. I., Connolly, C., & Diara, K. (1995) · Journal of Hypertension · doi:10.1097/00004872-199502000-00006 · Cited by 27
Socioeconomic inequalities in health
Hill, S. E. (2008) · Cited by 23
The role of anger and hostility in essential hypertension and coronary heart disease.
Diamond, E. L. (1982) · Psychological Bulletin · doi:10.1037//0033-2909.92.2.410 · Cited by 15
HISTORICAL AND CURRENT DEVELOPMENTS IN CORONARY- PRONE BEHAVIOR
Dembroski, T. M., & Czajkowski, S. M. (2013) · Psychology Press eBooks · doi:10.4324/9780203771679-5 · Cited by 15
COOK-MEDLEY HOSTILITY, ANGER, AND THE TYPE A BEHAVIOR PATTERN IN FINLAND
Greenglass, E. R. (1991) · Psychological Reports · doi:10.2466/pr0.68.4.1059-1066 · Cited by 14
Socioeconomic inequalities in health
m.fl, J. G. M. (2009) · Norsk Epidemiologi · doi:10.5324/nje.v12i1.498 · Cited by 5
Why do Some Behavioral Styles Place People at Coronary Risk?
Suls, J. M., & Sanders, G. S. (2013) · Psychology Press eBooks · doi:10.4324/9780203771679-4 · Cited by 5
Type A Behavior and Mortality from Coronary Heart Disease
Ragland, O. R., & Brand, R. (1988) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-198804000-00016 · Cited by 4
Research works printed but not linked: 3
- Cooper T, Detre T, Weiss SM. Coronary-prone behavior and coronary heart disease: a critical review. Circulation 1981 ;63: 1199-215.
- Osier M. Social class and health behavior in Danish adults: a longitudinal study. Public Health 1993;107:251-60.
- Rosenman RH, Brand RJ, Jenkins CD, et al. Coronary heart disease in the Western Collaborative Group Study: final follow-up experience of 8'/i years. JAMA 1975;233:872-7.
Cited by
Sorted by citations
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999) · Circulation · doi:10.1161/01.cir.99.16.2192 · Cited by 2,846
Roberts, B. W., Kuncel, N. R., Shiner, R., Caspi, A., & Goldberg, L. R. (2007) · Perspectives on Psychological Science · doi:10.1111/j.1745-6916.2007.00047.x · Cited by 2,361
Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwood, D. W., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000228 · Cited by 1,472
Gallo, L. C., & Matthews, K. A. (2003) · Psychological Bulletin · doi:10.1037/0033-2909.129.1.10 · Cited by 1,366
“, 1988), one found that cynical distrust predicted MI and cardiac death, but only before other risk factors were statistically controlled (Everson et al., 1997), and the final study found a positive and graded association between anger and likelihood of experiencing any coronary event during follow-up, even after cont…”
BackgroundResultWood, D., Backer, G. D., Færgeman, O., Graham, I. D., Mancia, G., & Pyörälà, K. (1998) · Atherosclerosis · doi:10.1016/s0021-9150(98)90209-x · Cited by 1,253
“For example, the relationship between hostility on coronary heart disease mortality in Finnish men was not mediated by blood pressure, LDL or HDL cholesterol([158]).”
Background
Metadata
- Authors
- Everson, S. A., Kauhanen, J., Kaplan, G. A., Goldberg, D. E., Julkunen, J., Tuomilehto, J., & Salonen, J. T.
- Affiliations
- University of Oulu (FI)
- Department of Health Services (US)
- Public Health Institute (US)
- University of Helsinki (FI)
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1997-07-15
- Volume
- 146
- Issue
- 2
- Pages
- 142-152
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2151070440
- Cited by
- 301
- References
- 67
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 8 · 2019: 8 · 2018: 8 · 2017: 7 · 2016: 10 · 2015: 10 · 2014: 12 · 2013: 11 · 2012: 21
- FWCI
- 6.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- Academy of Finland
- National Heart, Lung, and Blood Institute (HL-44199, R01HL044199)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- cynicism, hostility, cardiovascular mortality, all-cause mortality, myocardial infarction, behavioral risk factors, mediation, smoking, alcohol consumption, physical activity, body mass index, men, ischemic heart disease
- MeSH terms
- Adult, Cardiovascular Diseases, Cause of Death, Finland, Health Status, Hostility, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Risk Factors, Social Support, Socioeconomic Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
