Hostility and acute coronary syndrome in a transitional post-communist Muslim country: a population-based study in Tirana, Albania

Background: The study aims to assess: (i) the association of hostility with socio-demographic, psychosocial and coronary risk factors and (ii) the association of hostility with acute coronary syndrome (ACS) in post-communist secular though predominantly Muslim Albania. Methods: In a population-based case-control study conducted in Tirana in 2003-06, 464 non-fatal sequential ACS patients (368 men, 96 women, 87% response) and a population-sampled control group (n = 684; 449 men, 235 women, 65.5% response) provided data on Cynical Distrust, a measure of hostility. The correlates of hostility in the population sample were assessed using the general linear model and the association of hostility with ACS in the case-control comparison by multivariable-adjusted logistic regression. Results: In the population-based sample, hostility was related to age (inversely in men), social position, social mobility, relative income (all inverse in both sexes) and emigration of close family. In the case-control comparison, there was a strong graded relationship of hostility with ACS, independent of socio-demographic characteristics and conventional coronary risk factors, including lifestyle/behavioural factors [odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.18-1.34 in men, and OR = 1.17, 95% CI = 1.05-1.32 in women per unit score of hostility and OR = 5.3, 95% CI = 3.3-8.6 in men and OR = 3.1, 95% CI = 1.1-8.6 in women for upper versus lower tertiles]. Conclusion: This may be the first report from post-communist countries of Eastern and Southeastern Europe or from a Muslim population on the hostility trait in a population-representative sample. Hostility was independently associated with ACS. This requires confirmation, in particular, to exclude the possibility of reverse causality. Hostility may represent an informative risk factor in transitional populations.