The association between anger and hostility and risk factors for coronary heart disease in children and adolescents: A review

We reviewed the published literature on the association between anger and hostility and risk factors, both physiologic and behavioral, for coronary heart disease (CHD) in youth. The rationale for this review is based on observations that pathology and risk factors associated with CHD in adults, as well as patterns of expressing anger and hostility, often begin in childhood and adolescence; hence, it is imperative that we better understand the relationship between anger and CHD risk factors in young people if we are to develop interventions to change risk factor profiles. The first section discusses development of CHD riskfactors and describes studies of the pathologic precursors of CHD that demonstrate the early age of onset for pathologic changes, the tracking of physiologic and behavioral riskfactors from youth to adulthood, and the young age of initiation of behavioral risk factors associated with CHD. The second section discusses both the development and tracking of the constructs of anger and hostility. The third section provides a review of the epidemiologic studies that assess the association between anger or hostility and both physiologic and behavioral CHD risk factors among schoolage children. The final section provides an analysis and synthesis of the preceding sections and makes suggestions for further research.