Emotion 2001, Vol. l,No.2, 107-115 Copyright 2001 by the American Psychological Association, Inc. 1528-3542/01/S5.00 DOI: 10.1037//1528-3542.1.2.107 Linkages Between Facial Expressions of Anger and Transient Myocardial Ischemia in Men With Coronary Artery Disease Erika L. Rosenberg College of William and Mary Paul Ekman University of California, San Francisco Wei Jiang, Michael Babyak, R. Edward Coleman, Michael Hanson, Christopher O'Connor, Robert Waugh, and James A. Blumenthal Duke University Medical Center The authors examined whether facial expressions of emotion would predict changes in heart function. One hundred fifteen male patients with coronary artery disease underwent the Type A Structured Interview, during which time measures of tran- sient myocardial ischemia (wall motion abnormality and left ventricular ejection fraction) were obtained. Facial behavior exhibited during the ischemia measure- ment period was videotaped and later coded by using the Facial Action Coding System (P. Ekman & W. V. Friesen, 1978). Those participants who exhibited ischemia showed significantly more anger expressions and nonenjoyment smiles than nonischemics. Cook-Medley Hostility scores did not vary with ischemic sta- tus. The findings have implications for understanding how anger and hostility differentially influence coronary heart disease risk. If you do not have patience and hatred enters your mind, it is like a poisonous arrow piercing your heart. —Gampopa, The Jewel Ornament of Liberation Erika L. Rosenberg, Department of Psychology, College of William and Mary; Paul Ekman, Department of Psychia- try, University of California, San Francisco; Wei Jiang, Mi- chael Babyak, and James A. Blumenthal, Department of Psychiatry and Behavioral Sciences; R. Edward Coleman and Michael Hanson, Department of Radiology; Chris- topher O'Connor and Robert Waugh, Department of Medi- cine, Duke University Medical Center This project was part of a larger investigation on behavior and myocardial ischemia, which was funded by National Institutes of Health Grant HL43028. The research on facial expression and ischemia described in this article was funded by National Institutes of Health Grant HL46192. We are grateful to Gregory Feist, Barbara Fredrickson, David Kaplan, and Lisa Rosenberg for their helpful comments on previous versions of this article. Correspondence concerning this article should be ad- dressed to Erika L. Rosenberg who is now at the University of California, San Francisco, Department of Psychiatry, Hu- man Interaction Laboratory, 401 Parnassus Avenue, San Francisco, California 94143-0984. Electronic mail may be sent to jerika05@pacbell.net. Perhaps Gampopa was speaking metaphorically, but his statement not only withstands the test of time—it also holds up to the scrutiny of empirical investigation. Several lines of evidence suggest that anger is toxic to the heart. Hostility, an affective trait that reflects one's predisposition toward anger (Ek- man, 1984; Rosenberg, 1998), predicts the incidence of coronary head disease (CHD); Barefoot, Dahl- strom, & Williams, 1983; J. E. Williams et al., 2000), the extent of coronary atherosclerosis (R. B. Williams et al., 1980), the occurrence of myocardial ischemia in daily life (Gullette et al., 1997), and blood pressure reactivity to anger-provocative situations (Suarez, Harlan, Peoples, & Williams, 1993; Suarez & Wil- liams, 1989). Hostility scores are also associated with increases in plasma lipids and lipoproteins (Suarez, Bates, & Harralson, 1998). Furthermore, the affective state of anger confers its own risks on CHD. In addition to its well-documented effects on blood pressure (Ax, 1958; Schuler & O'Brien, 1997; Siegman, Anderson, Herbst, Boyle, & Wilkinson, 1992), anger is linked with dangerous car- diovascular consequences, especially for people who already have coronary artery disease. Participation in an anger-recall task reduces left ventricular ejection in coronary patients relative to healthy controls (Ironson 107 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.