We greatly appreciate Dr Friedman's comments and his description of potential neurobehavioral mechanisms for the association of anger with cardiovascular disease risk. In a study of a large group of men who live around the world, such as the Precursors Study, direct observation of speech patterns is not practical. We agree that the assessment of the response to stress used at baseline in our study1 may be less precise than the technique suggested by Dr Friedman. Such imprecision in exposure measurements leads to random misclassification of anger response that would tend to minimize associations. Thus, our findings may underestimate the true strength of the association between anger and cardiovascular disease.
Chang PP, Klag MJ. Speech Hesitation Pauses as a Measure of Neuronal Activity—Reply. Arch Intern Med. 2002;162(19):2251. doi: