The role of Friedman's pathogenic emotions (aggravation, irritation, anger and impatience or AIAI) in the initiation or aggravation of ischemic coronary heart disease (ICHD) may be due to direct neural/neuroendocrine factors or to indirect influences on other risk factors, such as smoking. In two studies of independent samples, data collected during an initial interview with male patients undergoing coronary angiography included (a) packyears of smoking and (b) current smoking status. The Jenkins Activity Survey (JAS), Life Change Scale (LCS) and Ketterer Stress Symptom Frequency Checklist (KSSFC) were administered during the first study. A mean split comparing high versus low groupings on each of the psychometric scales demonstrated that patients displaying Type B (44 per cent versus 22 per cent), depressive (53 per cent versus 22 per cent), anxious (44 per cent versus 26 per cent) and AIAI (51 per cent versus 23 per cent) characteristics were more likely to be current smokers ( JJ < 0.05) while not being any different from their counterparts in smoking history. In a second sample of 149 male angiography patients who were better educated and from a different region of the country, the KSSFC, Framingham Type A Scale, Cooke-Medley Hostility Scale (CMHS) and Perceived Social Support Scale were used. Only the AIAI Scale (25 per cent versus 12 per cent) and CMHS (26 per cent versus 12 per cent) were positively associated with current smoking, again independent of any baseline difference in smoking history. Present results are most parsimoniously explained by the thesis that high levels of AIAI interfere with smoking cessation or relapse avoidance.
The possible interrelationship of the ‘AIAI’ (i.e. aggravation, irritation, anger and impatience) of type A behavior and habitual caffeine use was examined as one plausible mechanism relating AIAI/TAB to coronary heart disease. Total daily caffeine intake was calculated be weighing the daily use of cups of coffee (1.0), glasses or cups of tea (0.5) and glasses, bottles or cans of pop (0.25) reported by 36 male patients undergoing diagnostic coronary angiography. High versus low groupings, according to two measures of type A behavior (the type A scale of the Jenkins Activity Survey and an ‘AIAI’ scale from the Ketterer Stress Symptom Frequency Checklist), were constructed and caffeine intake compared. The high AIAI group reported almost two more units (cups of coffee) per day, and was substantially younger than its counterparts. The influence of type A behavior on CAD/CHD may be mediated, in part or whole, by elevated caffeine intake.
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