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Hostility, CHD Incidence, and Total Mortality: A 25-Year Follow-Up Study of 255 Physicians
Abstract
High levels of hostility as assessed by a MMPI scale (Ho) have been found associated with increased levels of arteriographically documented coronary atherosclerosis. In this study we examined the relationship between hostility and subsequent health status in a 25-year follow-up of 255 medical students who completed the MMPI while in medical school. High Ho scores were found to be predictive of both clinical coronary disease incidence and total mortality.
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“However, in the early 1980s investigators began to study hostility in particular [159, 160], concluding that it was the primary “toxic” component of the Type A personality [161, 162].”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [159]
In the citing paper
“Within US samples, hostility appeared to elevate risk for 25-year all-cause mortality among male medical students [159]”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [159]
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Items 101–200 of 873
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Manuck, S. B., Kaplan, J. R., & Matthews, K. A. (1986) · Arteriosclerosis An Official Journal of the American Heart Association Inc · doi:10.1161/01.atv.6.1.2 · Cited by 148
Matthews, K. A., Manuck, S. B., & Saab, P. G. (1986) · Psychophysiology · doi:10.1111/j.1469-8986.1986.tb00618.x · Cited by 148
Virtanen, R., Jula, A., Salminen, J. K., Voipio‐Pulkki, L., Helenius, H. Y. M., Kuusela, T., & Airaksinen, J. K. E. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000088760.65046.cf · Cited by 140
Forgiveness, physiological reactivity and health: The role of anger
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“…to physical health (see Witvliet, 2001) was originally based primarily upon the well-tested associations between anger, hostility, Type A behavior and health (e.g., Barefoot et al., 1983; Booth-Kewley and Friedman, 1987; Smith, 1992; Linden et al., 1997; Miller et al., 1996; Williams, 1987).”
BackgroundPersonality, cancer and cardiovascular disease: A causal analysis
Eysenck, H. J. (1985) · Personality and Individual Differences · doi:10.1016/0191-8869(85)90003-0 · Cited by 134
The terrible twos--anger and anxiety: Hazardous to your health.
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The Pathogenicity of Behavior and Its Neuroendocrine Mediation
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“ponent, or related aspects of anger and its expression (1, 5, 19-21).”
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Self-citationThe Cambridge Handbook of Personality Psychology
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Self-citationEarle, T. L., Linden, W., & Weinberg, J. (1999) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(98)00075-0 · Cited by 127
“Several studies have suggested that one of the most valuable predictors of both the development and severity of cardiovascular disease is the propensity to experience and express hostility [5, 22]; however, the mechanism by which hostility leads to risk for CVD is also unknown.”
BackgroundNegative Affect and Health: The Importance of Being Earnest
Mayne, T. J. (1999) · Cognition & Emotion · doi:10.1080/026999399379203 · Cited by 134
Hostility as a Predictor of Survival in Patients With Coronary Artery Disease
Boyle, S. H., Williams, R. B., Mark, D. B., Brummett, B. H., Siegler, I. C., Helms, M. J., & Barefoot, J. C. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000138122.93942.4a · Cited by 125
“The CMHS and its subscales have been associated with coronary calcification (2), coronary heart disease (CHD) morbidity and mortality (3–6), and all-cause mortality (3,4,6,7) in prospective studies of healthy subjects.”
BackgroundSelf-citationHostility and the Metabolic Syndrome in Older Males: The Normative Aging Study
NIAURA, R. S., Banks, S. M., Ward, K. D., Stoney, C. M., Spiro, A., Aldwin, C. M., Landsberg, L., & Weiss, S. T. (2000) · Psychosomatic Medicine · doi:10.1097/00006842-200001000-00002 · Cited by 125
“Our study, however, examined the hostility-insulin relationship using Ho, which has been shown to be related to CHD and total mortality in several studies (1, 2, 4, 6, 9, 14), whereas previous studies have used a measure of aggression (32) and a measure of anger-out proneness (33) as proxies for hostility.”
BackgroundInfluentialEffects of Mental Stress in Patients With Coronary Artery Disease
Krantz, D. S., Sheps, D. S., Carney, R. M., & Natelson, B. H. (2000) · JAMA · doi:10.1001/jama.283.14.1800 · Cited by 122
A Link between Hostility and Disease: Poor Health Habits?
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“Although some studies with general populations or high risk groups have yielded a relationship between TABP and CHD (2, 3), it remains controversial whether TABP is a risk factor for CHD, because some studies have failed to show a contribution of TABP on CHD (4, 5) and others pointed to an association of the component…”
ResultLeon, 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
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“This is supported empirically by their significant associations with hypothesized disease risk factors (see 2, 3 for reviews) and by evidence that certain emotional factors are predictive of morbidity and mortality (4).”
BackgroundDEATH TAKES A HOLIDAY: MORTALITY SURROUNDING MAJOR SOCIAL OCCASIONS
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Self-citationEffects of mental stress on brachial artery flow-mediated vasodilation in healthy normal individuals
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“Controlled retrospective, prospective and cross-sectional studies have implicated depression [1–3], anxiety [3–6], and anger [7–10] as strong predictors of adverse out-”
BackgroundMethodDevelopment of the Japanese version of the Buss-Perry Aggression Questionnaire(BAQ).
Ando, A., Soga, S., Yamasaki, K., et al. (1999) · The Japanese journal of psychology · doi:10.4992/jjpsy.70.384 · Cited by 112
Hopelessness Predicts Mortality in Older Mexican and European Americans
Stern, S. L., Dhanda, R., & Hazuda, H. P. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200105000-00003 · Cited by 109
“It would be useful, too, to explore further the relationships among hopelessness, optimism and pessimism, depression, and other proposed psychological risk factors for physical illness and mortality, such as vital exhaustion (55–57), hostility (58), and anxiety (59).”
BackgroundHostility, Social Support, and Ambulatory Cardiovascular Activity
Benotsch, E. G., Christensen, A. J., & McKelvey, L. (1997) · Journal of Behavioral Medicine · doi:10.1023/a:1025530711432 · Cited by 109
Kop, W. J. (2003) · Brain Behavior and Immunity · doi:10.1016/s0889-1591(03)00051-5 · Cited by 110
Psychosocial factors associated with cardiovascular reactivity in older adults.
VITALIANO, P. P., Russo, J. E., Bailey, S. L., Young, H. M., & McCann, B. S. (1993) · Psychosomatic Medicine · doi:10.1097/00006842-199303000-00005 · Cited by 107
“10], The final model was significant [F(8,152) = 3.”
BackgroundPhysiological, psychological, and behavioral factors and white coat hypertension.
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Hostility, gender, and cardiac autonomic control
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“(45) have shown that measurement of hostility by the CookMedley scale is reliable over intervals as long as 4 years.”
BackgroundBrummett, B. H., Babyak, M. A., Barefoot, J. C., Bosworth, H. B., Clapp‐Channing, N. E., Siegler, I. C., Williams, R. B., & Mark, D. B. (1998) · Psychosomatic Medicine · doi:10.1097/00006842-199811000-00008 · Cited by 108
“Trait hostility, a predictor of CAD development (20-24), correlates positively with depression, r”
BackgroundMethodSelf-citationNeurobiology, cellular and molecular biology, and psychosomatic medicine.
Williams, R. B. (1994) · Psychosomatic Medicine · doi:10.1097/00006842-199407000-00006 · Cited by 106
“John Barefoot, who followed up 255 doctors who had taken the MMPI in medical school 25 years ago (4).”
BackgroundSelf-citationSmith, T. W., & Brown, P. C. (1991) · Journal of Behavioral Medicine · doi:10.1007/bf00867172 · Cited by 99
“Equal numbers of studies reporting a significant association between Ho scores and subsequent health (Barefoot et al., 1983, 1989; Shekelle et al., 1983) and failing to find such an association (Hearn et al., 1989; Leon et al., 1988; McCranie et al., 1986) have appeared in recent years.”
BackgroundInfluentialGuidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012):– Digest Version –
JCSJointWorkingGroup (2014) · Circulation · Cited by 105
Cardiovascular psychophysiology
Knardahl, S. (2000) · Annals of Medicine · doi:10.3109/07853890008995935 · Cited by 105
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The effects of type A behavior dimensions and optimism on coping strategy, health, and performance
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“has been found to be associated with illness and coronary heart disease (Barefoot et al., 1983; Williams et al., 1985).”
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“In that study, which used the Cook-Medley Scale (10, 11) to assess hostile attitudes, thromboxane B2 levels in blood exiting a bleeding time wound were greater among hostile Type A individuals than nonhostile Type A individuals.”
BackgroundMethodHostility, Interpersonal Interactions, and Ambulatory Blood Pressure
Brondolo, E. N., Rieppi, R., Erickson, S. A., Bagiella, E., Shapiro, P. A., McKinley, P. S., & Sloan, R. P. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000097329.53585.a1 · Cited by 98
“moderate test–retest reliability over extended periods (3,7,44).”
Hostility, the metabolic syndrome, and incident coronary heart disease.
NIAURA, R. S., Todaro, J. F., Stroud, L. R., Spiro, A., Ward, K. D., & Weiss, S. T. (2002) · Health Psychology · doi:10.1037/0278-6133.21.6.588 · Cited by 104
“Results of the present study are consistent with other studies demonstrating that Ho is associated with and predicts incident CHD above and beyond the influence of traditionally assessed CHD risk factors, including blood lipid profiles, sociodemographic characteristics, and certain behavioral factors, such as alcohol…”
BackgroundResultIribarren, C., Jacobs, D. R., Kiefe, C. I., Lewis, C. E., Matthews, K. A., Roseman, J. M., & Hulley, S. B. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.06.007 · Cited by 97
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“Hostility has been implicated in heart disease (Barefoot et al. 1983; Miller et al. 1996) and all-cause, general mortality (Barefoot et al.”
BackgroundSociodemographic diversity and behavioral medicine.
Whitfield, K. E., Weidner, G., Clark, R., & Anderson, N. B. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.3.463 · Cited by 109
Anger and the Heart: Perspectives on Cardiac Risk, Mechanisms and Interventions
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“Constructs historically associated with Type A that may be related to low agreeableness, such as hostility (23,24) as well as cynicism (16) measured on the Minnesota Multiphasic Personality Inventory, have predicted the development of CHD and mortality.”
BackgroundSiegler, I. C., Costa, P. T., Brummett, B. H., Helms, M. J., Barefoot, J. C., Williams, R. B., Dahlstrom, W. G., Kaplan, B. H., VITALIANO, P. P., Nichaman, M. Z., et al. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000088583.25140.9c · Cited by 98
“It is associated with the development of CHD (18–20), recurrent CHD (21), coronary artery calcification (22), CHD risk factors (23–27) and all-cause mortality (18, 19, 28), especially in prospective studies started on older samples (29, 30).”
BackgroundSelf-citationProspective Study of a Self-Report Type A Scale and Risk of Coronary Heart Disease
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Hostility Is Associated With Increased Platelet Activation in Coronary Heart Disease
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“INTRODUCTION Recent studies exploring the role of psychological factors in CHD have identified hostility and depression as factors potentially associated with CHD (1-6).”
BackgroundDo Negative Emotions Mediate the Association between Socioeconomic Status and Health?
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“The link between hostility and health observed in the present study is in line with several previous studies using health indices alternative to those used by ourselves [1–6].”
BackgroundResultThe longitudinal effects of social support and hostility on depressive tendencies
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A Test of the Psychosocial Vulnerability and Health Behavior Models of Hostility
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“(22) found that hostility was predictive of hypertension.”
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Anger and Incident Heart Disease in the Caerphilly Study
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Miller, G. E., Freedland, K. E., Carney, R. M., Stetler, C., & Banks, W. A. (2003) · Journal of Behavioral Medicine · doi:10.1023/a:1026273817984 · Cited by 75
Cognitive, Behavioral, and Affective Correlates of the Cook and Medley Hostility Scale
Pope, M. K., Smith, T. W., & Rhodewalt, F. T. (1990) · Journal of Personality Assessment · doi:10.1080/00223891.1990.9674015 · Cited by 79
Harassment, hostility, and Type A as determinants of cardiovascular reactivity during competition
Diamond, E. L., Schneiderman, N., Schwartz, D. A., SMITH, J. C., Vorp, R., & Pasin, R. D. (1984) · Journal of Behavioral Medicine · doi:10.1007/bf00845385 · Cited by 73
Openness to Experience and Mortality in Men: Analysis of Trait and Facets
Turiano, N. A., Spiro, A., & Mroczek, D. K. (2012) · Journal of Aging and Health · doi:10.1177/0898264311431303 · Cited by 72
“Indeed, it may be the case that certain facets of traits are related to health processes such is the case with the hostility facet of the Type A behavior pattern (Barefoot et al., 1983).”
Background
Metadata
- Authors
- Barefoot, J. C., Dahlstrom, G. W., & Williams, R. B.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- ORCID
- Williams, Redford B.
- Venue
- Psychosomatic Medicine
- Published
- 1983-03
- Volume
- 45
- Issue
- 1
- Pages
- 59-63
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2072085129
- Cited by
- 866
- References
- 0
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 3 · 2023: 4 · 2022: 3 · 2020: 48 · 2019: 2 · 2018: 8 · 2017: 4 · 2016: 11 · 2015: 6 · 2014: 19 · 2013: 14 · 2012: 20
- FWCI
- 20.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- hostility, coronary heart disease incidence, all-cause mortality, coronary artery disease, medical students, long-term follow-up, risk prediction
- MeSH terms
- Adult, Angina Pectoris, Coronary Disease, Follow-Up Studies, Hostility, Humans, Male, Middle Aged, MMPI, Myocardial Infarction, Personality, Physicians
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