***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Recent literature review s have question ed hostility as a risk factor for heart disease . However , controversy persists due to the rarity of large-scale prospect i ve cohort studies of initially healthy population s. METHODS We prospect ively 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 Prospect i ve 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 question naire . 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 Three prospect i ve studies from the early 1980s found that high scores on the  Hostility ( Ho ) Scale of the Minnesota Multiphasic Personality Inventory ( MMPI ) were associated with an increased incidence of coronary heart disease ( CHD ) and mortality from CHD and other causes . In the current study , the association between the Ho score and subsequent health status was examined in a 20-year follow-up of 620 general medical patients who completed the MMPI between 1962 and 1965 .  Univariately , the Ho score from the MMPI was a significant factor for predicting the development of CHD , CHD-related mortality , and total mortality . When two simple risk factors for CHD -- age and sex -- were also considered , however , the MMPI Ho score was no longer a significant predictive factor BACKGROUND France has a substantially lower level of premature mortality from cardiovascular diseases ( CVD ) relative to its comparators . Compared with Northern Irel and , France has one-half the rate , despite having a similar cardiovascular risk profile to Northern Irel and . In this prospect i ve longitudinal study the psychosocial risk hypothesis for CVD was tested . METHOD A cohort of 9758 men ( 7359 in France and 2399 in Northern Irel and ) aged 50 - 59 years who were initially free of any CVD were recruited . At baseline the subjects completed a psychosocial question naire , measuring hostility , depression , social support , and the Type A behaviour pattern .  At 5-years follow-up their clinical status was determined . RESULTS Multivariate analysis indicated that , contrary to prediction , France had a substantially more negative psychosocial risk profile than Northern Irel and . The psychosocial risk factors were not successful at predicting at 5-years follow-up the hard clinical endpoint of definite fatal/non-fatal myocardial infa rct ion . In the case of the softer clinical endpoint , angina pectoris/unstable angina , only depression predicted outcome with a small effect size . CONCLUSION The findings provide little support for the psychosocial risk hypothesis . The psychosocial risk profile was more negative in France , the opposite of that predicted . The finding of a relationship between depression and angina may reflect a tendency for individuals who respond negatively on mood state to report more cardiac symptoms irrespective of physical disease state Since the last comprehensive review of anticoagulation in acute myocardial infa rct ion four additional r and omized control trials have been reported . The overwhelming majority of all trials favored anticoagulation .  Rates of thromboembolism were higher in the control , and hemorrhagic complications in the anticoagulated group . Pooling of all r and omized control trials gives mean case fatality rates of 19.6 % for the control and 15.4 % for the anticoagulated group , a relative reduction of 21 % ( P less than 0.05 or less than 0.001 , depending on the analytic method ) . Five of six r and omized control trials reported " no effect " because the difference favoring anticoagulation was not statistically significant . However , sample sizes in these " negative " papers were too small to protect against missing a 21 % reduction in true case fatality rate due to anticoagulation ( beta greater than 0.10 ) . All patients who present no specific contraindication should receive  anticoagulants  during hospitalization for infa rct ion The  Western Collaborative Group Study  is a prospect i ve study of 3,154 employed men aged 39 to 59 years .  Ischemic heart disease occurred in 257 subjects during 8.5 years of follow-up . Risk of coronary heart disease was studied with use of the multiple logistic risk model . The incidence of coronary heart disease had a highly significant association with serum cholesterol level , behavior pattern , cigarette smoking and systolic blood pressure in younger ( 39 to 49 years ) and older ( 50 to 59 years ) men and also with age and corneal arcus in the younger group . Type A behavior pattern was strongly related to the incidence of coronary disease in both age groups , independent of interrelations of behavior patterns with any other risk factor BACKGROUND Recent laboratory and epidemiological studies have suggested that high levels of anger may increase the risk of coronary heart disease ( CHD ) . METHODS AND RESULTS We examined prospect ively the relationship of anger to CHD incidence in the Veterans Administration Normative Aging Study , an ongoing cohort of older ( mean age , 61 years ) community-dwelling men . A total of 1305 men who were free of diagnosed CHD completed the revised Minnesota Multiphasic Personality Inventory ( MMPI-2 ) in 1986 .  Subjects were categorized according to their responses to the  MMPI-2 Anger Content Scale  , which measures the degree to which individuals have problems controlling their anger . During an average of 7 years of follow-up , 110 cases of incident CHD occurred , including 30 cases of nonfatal myocardial infa rct ion hostility . ( MI ) , 20 cases of fatal CHD , and 60 cases of angina pectoris . Compared with men reporting the lowest levels of anger , the multivariate-adjusted relative risks among men reporting the highest levels of anger were 3.15 ( 95 % confidence interval ) [ CI ] : 0.94 to 10.5 ) for total CHD ( nonfatal MI plus fatal CHD ) and 2.66 ( 95 % CI : 1.26 to 5.61 ) for combined incident coronary events including angina pectoris . A dose-response relation was found between level of anger and overall CHD risk ( P for trend , .008 ) . CONCLUSIONS These data suggest that high levels of expressed anger may be a risk factor for CHD among older men An extensive psychosocial question naire was administered to 1674 coronary free individuals participating in the Framingham Heart Study between 1965 and 1967 . The respondents were followed for the development of coronary heart disease ( CHD ) over an eight-year period . Women ( aged 45 - 64 years ) who developed CHD scored significantly higher on the Framingham Type A behavior ,  suppressed hostility  ( not showing or discussing anger ) , tension , and anxiety symptoms scales than women remaining free of CHD . Type A women developed twice as much CHD and three times as much angina as Type B women . In a multivariate analysis , Framingham Type A behavior and not discussing anger were independent predictors of CHD incidence when controlled for the st and ard coronary risk factors and other psychosocial scales . Men exhibiting Framingham Type A behavior , work overload , suppressed hostility ( not showing anger ) , and frequent job promotions were at increased risk of developing CHD ( especially in the age group 55 - 64 years ) . Among men aged 45 - 64 years , Type A behavior was associated with a twofold risk of angina , myocardial infa rct ion , and CHD in general , as compared to Type B behavior . The association was found only among white-collar workers and was also independent of the st and ard coronary risk factors and other psychosocial scales . This prospect i ve study suggests that Type A behavior and suppressed hostility may be involved in the pathogenesis of CHD in both men and women Abstract Prospect i ve study of 2750 employed men who completed a computer-scored test question naire measuring the coronary-prone Type A behavior pattern showed that high scorers had twice the incidence of new coronary heart disease as low scorers over a four-year period . Subjects with different initial clinical manifestations of coronary disease did not differ from one another in their Type A test scores . The double-blind design of these studies and the orderly relation of Type A scores to coronary-disease risk suggest that the coronary-prone behavior pattern is prospect ively linked to the pathogenesis of coronary heart disease . The findings also indicate that the test question naire used is a valid means of measuring some of the ways in which behavior contributes to coronary risk . ( N Engl J Med 290:1271–1275 , 1974 
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We conclude that the existing data do not support a meaningful clinical relationship between current measurements of these traits and the development of CVD .