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A stress assessment survey was administered and blood samples collected on 370 subjects in Department of Defense organizations and a civilian hospital. A path analytic model was proposed, hypothesizing that intraorganizational, extraorganzational, and individual characteristics were related to stress and its behavioral and physiological consequences. Exploratory path analysis resulted in the identification of paths that led to the primary behavioral consequence of intent to quit the organization. Also identified were paths that led to an increase in the medical consequence variable: the ratio of total cholesterol divided by high density lipoprotein (HDL) cholesterol. The data suggested that intraorganizational variables affect one’s intention to quit an organization indirectly through their impact on job stress and job satisfaction. Home-family relationships affected job stress indirectly through their affect on life stress. One’s potential for developing coronary artery disease as measured by the “cholesterol ratio” was affected by individual characteristics. The ratio was higher for individuals who were male, overweight, smoked, and did not exercise.

Plasma concentrations and urinary excretions of various hormones and hormone metabolites were measured In four groups. Group 1 was composed of 13 men with prior myocardial infarction; Group 2 contained 35 clinically normal men; Group 3 consisted of 44 men with normal coronary arteriograms; and Group 4 was composed of 25 men with severe coronary artery disease shown on arteriogram but no Infarction. There were four major findings: Group 1 had significantly higher 24-hour mean plasma concentrations of estrone (E1), dehydrolsoandrosterone (DHA), and dehydroisoandrosterone sulfate (DHAS) than Group 2, while Group 3 had the same levels as Group 4; Group 4 had significantly lower urinary excretion of androsterone glucuronlde (AG) than Group 3, while Group 1 excreted normal amounts. There are three possible explanations for these findings: 1) myocardial Infarction occurring in men with coronary artery disease may elevate the plasma levels of E1, DHA, and DHAS and eliminate the prelnfarctlon depression of urinary AG levels; 2) higher than average levels of E1, DHA, DHAS, and AG may favor the development of Infarction In men with coronary artery disease; 3) higher than average levels of E1, DHA, DHAS, and AG may favor survival from any infarction that occurs In men with coronary artery disease. Experimental and epldemlologlcal evidence seems to favor the third possibility. (Arteriosclerosis 2:58-67, January/February 1982) T he classical, established risk factors for coronary artery disease are hyperlipidemia, hypertension, and cigarette smoking. In addition, the fact that women show a strikingly lower death rate from coronary disease than men has been recognized for over 40 years.

To further understand the hormonal mechanisms linking behavior pattern and coronary artery disease (CAD), we Investigated the relationship between 0930-hour plasma cortisol and cholesterol In relatively young males who had undergone coronary anglography and In a subgroup of Individuals who had undergone the structured interview for classification of behavior pattern. A statistically significant association (p < 0.05) was found between cortisol and cholesterol for Individuals who had either minimal CAD (20% to 49% narrowing) or significant CAD (3=50% narrowing), but not for subjects without CAD. An association between cortisol and cholesterol was also found to be significant S ince serum cholesterol is one of the most important risk factors for coronary heart disease, numerous studies have been made to identify factors that control its levels in blood. Extensive evidence now indicates that cholesterol metabolism is controlled by a complex system involving genetics, sex, diet, and age. Some evidence also indicates that behavior pattern may have an influence on cholesterol concentrations. Individuals with Type A behavior, for instance, have higher serum cholesterol concentrations and have more severe and extensive coronary atherosclerosis than do Type B individuals.

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