Previous research has linked the Type A coronary-prone behavior pattern to angiographically documented severity of coronary atherosclerosis (CAD). The present study sought through component scoring of the Type A Structured Interview (SI) to determine what elements of the multidimensional Type A pattern are related to coronary disease severity in a selected group of patients with minimal or severe CAD. Multivariate analyses controlling for the major risk factors showed no relationship between global Type A and extent of disease. Of all attributes measured, only Potential for Hostility and Anger-In were significantly and positively associated with the disease severity, including angina symptoms and number of myocardial infarctions. Further analysis revealed that Potential for Hostility and Anger-In were interactive in their association, such that Potential for Hostility was associated with disease endpoints only for patients who were high on the Anger-In dimension. These findings support previous research in suggesting that anger and hostility may be the critical aspects of the Type A pattern in predisposing individuals to risk of CAD.

We tested the hypothesis that hostility is associated with increased relative risk (RR) for coronary death and nonfatal myocardial infarction among participants in the prospective Multiple Risk Factor Intervention Trial (MRFIT). Cases (N = 192) were compared with matched controls (N = 384) on a variety of behavioral characteristics associated with the Type A behavior pattern (TABP), including three different but interrelated components of hostility. Logistic regression analyses revealed that only two of the eight TABP attributes analyzed on the overall sample were significant. Only total Potential for Hostility, when dichotomized into "low" and "high" categories, and the antagonistic interpersonal component of hostility (Stylistic Hostility) had positive unadjusted associations with coronary heart disease (CHD) incidence (RR = 1.7, p = 0.003; and RR = 1.5, p = 0.016, respectively). The global TABP and related paralinguistic attributes were not significantly related to CHD incidence. After adjustment for the traditional risk factors of age, serum cholesterol, blood pressure, and cigarette smoking, only dichotomous Potential for Hostility showed a significant relative risk (RR = 1.5, p = 0.032). Ordinal logistic regression revealed a nonsignificant effect.(ABSTRACT TRUNCATED AT 250 WORDS)

The present study tested the general hypothesis that behavioral attributes most predictive of the incidence of coronary heart disease (CHD) in epidemiological research would also be most predictive of sympathetic autonomic nervous system (ANS) arousal in response to performance challenges. Subjects (n = 50) were challenged to respond rapidly and accurately on three tasks involving either perceptual-motor or cognitive skills, while the experimenter monitored blood pressure, heart rate, and galvanic skin potential. The hypothesis was generally confirmed in that (1) type A subjects showed significantly greater cardiovascular changes indicative of sympathetic ANS arousal than type B subjects, (2) the Rosenman and Friedman structured interview was a better predictor of this arousal than the Jenkins Activity Survey, as is the case in CHD, and (3) the stylistic and behavioral components of the type A pattern (as defined by the structured interview) which are most predictive of CHD were also found to be the best predictors of challenge-induced sympathetic ANS arousal. The implications of these results for refinements in the definition, assessment, and modification of coronary-prone behavior are discussed.

The aim of the present study was to identify factors that account for similarities and discrepancies in classification of Type A and B behavior by the Structured Interview (SI) and by the Jenkins Activity Survey (JAS). Two diverse samples were administered the SI and the JAS. SI questions were coded for content of response and psychomotor behavior during the interview. Frequency of specific Type A speech characteristics and clinical judgments were also rated. Analyses revealed that the SI estimate of Type A could be predicted by the subjects' promptness of response, voice emphasis, hurried speech, and judgements of competitiveness, hostility, and energy level. The latter three judgments were also measured somewhat by the JAS. Interviewer ratings of subjects' overt motor behavior and appearance did not relate to SI assessments. The JAS estimate of Type A could be predicted by subjects' reports of pressured drive, which was also measured by SI. This pattern of interrelationships was similar in the two samples in spite of sample differences in age, health status, geographical location, interview and JAS forms, and raters. Overall, the correlations between the SI and JAS assessment were low and suggested a considerable degree of independence between the two measures. In light of these results, they should not be used as interchangeable measures of Type A behavior.

In a previous study of patients undergoing angiography at Duke University Medical Center, we reported that of all components of the Type A behavior pattern (TABP), only Potential for Hostility and Anger-In were significantly associated with extent of coronary artery disease (CAD). The present study was undertaken to replicate these findings using a different patient population. Tape-recorded structured interviews from 125 angiography patients at Massachusetts General Hospital were blind scored using the component scoring system employed in the Duke study. The results confirmed our previous findings. Global TABP was completely unrelated to extent of CAD, while Potential for Hostility and Anger-In were significant independent predictors of disease severity. These findings argue for a reconceptualization of the manner in which the TABP is defined and assessed.

Recent reviews have linked Potential for Hostility derived from the Structured Interview (SI) to coronary artery disease, independent of the global Type A pattern. The present study examined the construct validity of Potential for Hostility ratings by correlating Potential for Hostility with 21 scales from four widely used anger/hostility measures: 7 scales from the Anger Self-Report, 8 scales from the Buss-Durkee Hostility Inventory, the total score from the Novaco Anger Inventory, and 5 scales from the Multidimensional Anger Inventory. The pattern of correlations revealed that Potential for Hostility was significantly related to scales reflecting awareness and arousal of anger, particularly the verbal expression of anger. To identify underlying anger dimensions, the 21 scales were factor-analyzed. Examination of two and three rotated principal components confirmed previous solutions. The first component, representing anger-arousing and -eliciting situations and anger awareness, was labeled Experience of Anger. The second component, consisting of scales dealing with either physical assault or verbal expression of anger, was labeled Expression of Anger. When a third factor was retained, it contained scales of suspicion, mistrust-suspicion, and guilt: It was therefore labeled Suspicion-Guilt. Potential for Hostility was correlated only with the Expression of Anger factor in the two-factor solution; in the three-factor solution, Potential for Hostility was correlated equally with the Experience of Anger and Expression of Anger factors but was not correlated with the Suspicion-Guilt factor. The implications of these results for the assessment of hostility are discussed.

Two studies examined the blood pressure and heart rate responses of female college students categorized as Type A or B according to the Rosenman and Friedman structured interview technique. In Study I, unlike male college students, the interview‐defined Types did not differ significantly in physiological response to either a cold pressor test or reaction time task under instructional conditions that emphasized the difficulty of the tasks. Consistent with data from male subjects, however, interview ratings of potential for hostility were found for both Types to correlate positively with changes in systolic blood pressure and heart rate for the reaction time task. In Study II, Type A women compared with Type Bs did show greater increases in systolic blood pressure during the structured interview and in the course of a challenging American history quiz, but as in Study I, not in a high‐incentive reaction time task. These results suggest that under some conditions (e.g., moderately challenging interpersonal exchanges) women evidencing the Type A pattern may show larger hemodynamic responses than Type Bs, but important differences may exist between the sexes in the types of situations which evoke such responses.

HIV-1 infection is associated with serious cardiovascular complications, but the roles of HIV-1, viral proteins, and highly active antiretroviral therapy (HAART) drugs are not understood. HAART decreases the overall risk of heart disease but leads to metabolic disturbances and possibly coronary artery disease. We investigated toxicities of HIV-1, HIV-1 glycoprotein 120 (gp120), and HAART drugs for human coronary artery endothelial cells (CAECs), brain microvascular endothelial cells, and neonatal rat ventricular myocytes (NRVMs). HIV-1 and gp120, but not azidothymidine (AZT), induced apoptosis of NRVMs and CAECs. Ethylisothiourea, an inhibitor of nitric oxide synthase, inhibited apoptosis induction by gp120. AZT, HIV-1, and gp120 all damaged mitochondria of cardiomyocytes. HAART drugs, AZT, and indinavir, but not HIV-1, produced intercellular gaps between confluent endothelial cells and decreased transendothelial electrical resistance. In conclusion, HIV-1 and gp120 induce toxicity through induction of cardiomyocyte and endothelial cell apoptosis. HAART drugs disrupt endothelial cell junctions and mitochondria and could cause vascular damage.