Association of psychosocial traits with coronary artery calcium development and progression: The Multi-Ethnic Study of Atherosclerosis

Background: Coronary artery calcium (CAC) is a well-established quantifiable risk factor for cardiovascular disease (CVD). We examined the association of anger, hostility, anxiety, and depression with the development and progression of CAC. Methods: We studied the association of these psychosocial traits with CAC among participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Anger was measured using the Spielberger Trait Anger questionnaire, hostility using a modified Cook-Medley Hostility questionnaire, anxiety using the Spielberger Trait Scale, and depression using the Center for Epidemiological Studies Depression Scale (CES-D). Among the subsample of participants with CAC = 0 at the beginning of the study period, Poisson regression models were used to determine the relative risk of developing CAC>0 over the study period. In the subsample that developed CAC>0, we used linear regression models to estimate the average increase in CAC associated with a unit increase in psychosocial trait. Results: Median time of follow-up was 9.4 years (range 8.0–11.4 years). Cross-sectional analyses at baseline revealed no association of any of the psychosocial traits with the presence or magnitude of CAC (anger: RR 0.98, p < 0.01; hostility: RR 1.01, p = 0.25; anxiety: RR 0.99, p < 0.01; depression: RR 0.99, p < 0.01 [not statistically significant after adjustment for covariates]). No association was detected between the traits and development of CAC (anger: RR 0.99, p = 0.23; hostility: RR 1.01, p = 0.68, anxiety: RR 1.00, p = 0.49; depression: RR 1.00, p = 0.51). We also found no association between any of the traits and progression of CAC (anger: beta −3.21, p = 0.08; hostility: beta 2.28, p = 0.43; anxiety: 3.45, p = 0.02 [not statistically significant after adjustment for covariates]; depression: beta −1.46, p = 0.11). Conclusions: We found no association between anger, hostility, anxiety, or depression and CAC, suggesting these personality traits are not independent risk factors for CVD.