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Association of anger proneness, depression and low social support with peripheral arterial disease: the Atherosclerosis Risk in Communities Study

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA

Janice E Williams

La Grange, GA, USA, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA

Pamela J Schreiner

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA

Alan T Hirsch

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA

Aaron R Folsom

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA, folsom{at}epi.umn.edu

There is mounting evidence to suggest that psychosocial factors, including anger proneness, depression and social isolation, are risk factors for cardiovascular disease. Nevertheless, evidence relating these factors to peripheral arterial disease (PAD) and intermittent claudication remains sparse. Using data from the Atherosclerosis Risk in Communities Study, we analyzed the relationship of psychosocial variables (Spielberger anger score, depression score from the Maastricht questionnaire, and a perceived social support scale) at study visit 2 with incident PAD (ankle-brachial index 0.9; a hospital discharge diagnosis of PAD, leg amputation, or leg revascularization procedures; or intermittent claudication). In 12 965 middle-aged adults with no prior history of PAD, 854 developed PAD over a mean follow-up time of 9.7 years, yielding an incidence rate of 6.8 per 1000 person years. A modest, monotonic dose-response, positive association between anger proneness and incident PAD was observed in a multivariable model: relative risk (RR) = 1.15 (95% confidence interval (CI) 0.99-1.38) in the moderate anger group and RR = 1.38 (95% CI 1.08-1.76) in the high anger group, compared with the low anger group. When compared with a low level of depressive symptoms, moderate and high levels of depressive symptoms were also associated with greater incident PAD, with multivariable RRs of 1.20 (95% CI 0.99-1.45) and 1.44 (95% CI 1.19-1.74) respectively. There was no association of perceived level of social support with the occurrence of PAD. Anger proneness and depressive symptoms may be associated with the occur-rence of PAD, as for other atherosclerotic syndromes. These findings may warrant confirmation in further studies and, if causal, could serve as a unique target for a PAD prevention trial.

Key Words: anger proneness • depression • peripheral arterial disease • population study • risk factors • social support

Vascular Medicine, Vol. 10, No. 3, 199-206 (2005)
DOI: 10.1191/1358863x05vm622oa


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