Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: The multi-ethnic study of atherosclerosis

Tetsuya Ohira, Ana V.Diez Roux, Joseph F. Polak, Shunichi Homma, Hiroyasu Iso, Bruce A. Wasserman

Research output: Contribution to journalArticlepeer-review


Objective: Carotid arterial wall thickness, measured as intima-media thickness (IMT), is an early subclinical indicator of cardiovascular disease. Few studies have investigated the association of psychological factors with IMT across multiple ethnic groups and by sex. Methods: We included 6561 men and women (2541 whites, 1790 African Americans, 1436 Hispanics, and 794 Chinese) aged 45 to 84 years who took part in the first examination of the Multi-Ethnic Study of Atherosclerosis. Associations of trait anger, trait anxiety, and depressive symptoms with mean values of common carotid artery (CCA) and internal carotid artery (ICA) IMTs were investigated using multivariable regression and logistic models. Results: In age-, sex-, and race/ethnicity-adjusted analyses, the trait anger score was positively associated with CCA and ICA IMTs (mean differences per 1-standard deviation increment of trait anger score were 0.014 [95% confidence interval {CI} = 0.003-0.025, p = .01] and 0.054 [95% CI = 0.017-0.090, p = .004] for CCA and ICA IMTs, respectively). Anger was also associated with the presence of carotid plaque (age-, sex-, and race/ethnicity-adjusted odds ratio per 1-standard deviation increase in trait anger = 1.27 [95% CI = 1.06-1.52]). The associations of the anger score with thicker IMT were attenuated after adjustment for covariates but remained statistically significant. Associations were stronger in men than in women and in whites than in other race/ethnic groups, but heterogeneity was only marginally statistically significant by race/ethnicity. There was no association of depressive symptoms or trait anxiety with IMT. Conclusions: Only one of the three measures examined was associated with IMT, and the patterns seemed to be heterogeneous across race/ethnic groups. Abbreviations: BMI = body mass indexBP = blood pressureCCA = common carotid arteryCES-D = Center for Epidemiological Studies Depression ScaleICA = internal carotid arteryIMT = intima-media thicknessMESA = Multi-Ethnic Study of AtherosclerosisMET = metabolic equivalentSTAXI = Spielberger Trait Anger and Anxiety Inventory

Original languageEnglish (US)
Pages (from-to)517-525
Number of pages9
JournalPsychosomatic medicine
Issue number5
StatePublished - Jun 2012


  • anger
  • anxiety
  • carotid artery wall thickness
  • depressive symptoms
  • intima-media thickness
  • race/ethnicity

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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