['Hostility may predict coronary heart disease morbidity and mortality, as well as the metabolic syndrome. We tested to see if high levels of the attitudinal and emotional aspects of hostility lead to progression of carotid atherosclerosis in women and if the metabolic syndrome is a mediator of the association.', 'Two hundred nine healthy women were followed during the perimenopausal and postmenopausal periods. Carotid artery ultrasound scans measured intima-media thickness (IMT) an average 7.4 (SD = 0.9, range 4.2-10.8) and 10.5 years (SD = 1.1, range = 6.9-13.0) after baseline. Hostility was measured at baseline and at the first carotid scan with Spielberger Trait Anger (being angry frequently) and Anger In (suppressing angry feelings) scales, and the Cook-Medley Hostility Inventory (hostile, cynical attitudes toward others). Metabolic syndrome was measured at the study entry and through the second carotid scan.', 'Baseline Trait Anger scores predicted an increase in IMT across 3 years (p < .05) and predicted the risk for developing the metabolic syndrome (p < .05). The risk for developing the metabolic syndrome, in turn, predicted an increase in IMT across 3 years (p < .05). Anger suppression and cynical attitudes were not associated with progression of carotid atherosclerosis.'] Do trait anger and the metabolic syndrome predict progression of carotid atherosclerosis in healthy middle-aged women?