Prospective cohort study of hostility and the risk of cardiovascular disease mortality

Background Recent literature reviews have questioned hostility as a risk factor for heart disease. However, controversy persists due to the rarity of large-scale prospective cohort studies of initially healthy populations. Methods We prospectively investigated the association between hostility and cardiovascular (and all-cause) mortality among 20,550 men and women, 41–80 years of age, participating in the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk), United Kingdom study. Participants were recruited by post from general practice age–sex registers and subsequently attended health checks that included the assessment of coronary disease risk factors. Hostility assessment was completed by postal questionnaire. Results During mean follow-up of 6 years, 1284 deaths were recorded including 481 from cardiovascular disease (CVD). Hostility was not associated with CVD mortality, after adjustment for age and prevalent disease, in either men (rate ratio for a 1 SD decrease in hostility score, representing increased hostility, 1.09; 95% confidence interval 0.98–1.22) or in women (rate ratio 1.00; 95% confidence interval 0.86–1.26). Subgroup analysis suggested hostility may be associated with CVD mortality (independent of age, prevalent disease and cigarette smoking) for participants reporting very high hostility and for those aged less than 60 years. Conclusions Hostility was not associated with an increased risk of cardiovascular mortality in this population study of older adults.