Type A behavior and angiographically documented coronary atherosclerosis in a sample of 2,289 patients.

Abstract

To determine the relationship between Type A behavior pattern and angiographically documented coronary atherosclerosis (CAD), we analyzed risk factor, behavioral, and angiographic data collected on 2,289 patients undergoing diagnostic coronary angiography at Duke University Medical Center between 1974 and 1980. Multivariable analyses using ordinal logistic regression techniques showed that Type A behavior as assessed by the structured interview (SI) is significantly associated with CAD severity after age, sex, hyperlipidemia, smoking, hypertension, and their various significant interactions were controlled for. This relationship, however, is dependent upon age. Among patients aged 45 or younger, Type A's had more severe CAD than did Type B's; among patients aged 46-54, CAD severity was similar between Type A's and B's; and among patients 55 and older, there was a trend toward more severe CAD among Type B's than among Type A's. These Type A-CAD relationships did not appear to be the result of various factors relating to the selection of patients for angiography. Type A behavior as assessed by the Jenkins Activity Survey was unrelated to CAD severity. These findings suggest that SI-determined Type A behavior is associated with more severe CAD among younger patients referred for diagnostic coronary angiography. The reversal of the Type A-CAD relationship among older patients may be due to survival effects. Inadequate sample sizes, use of assessment tools other than the SI, and failure to consider the Type A by age interaction could account for failures to find a Type A-CAD relationship in other studies. We conclude that the present findings are consistent with the hypothesis that Type A behavior is involved in the pathogenesis of CAD, but only in younger age groups. The Type A effect in the present data is small relative to that of both smoking and hyperlipidemia, however, and future research should focus more specifically on the hostility and anger components of Type A behavior, particularly in younger samples.

Components of hostility and the severity of coronary artery disease.

“…Finally, the associations thus described in the above hypotheses will be observed primarily in younger patients. The rationale for the third hypothesis is based on a recent study of 2289 patients in which an association between TABP and CAD severity was obtained only in younger patients (19). Thus, older patients may reflect a group of particularly hardy survivors in which psychosocial influences on disease are resisted by constitutional makeup.…”

Prediction of type A behaviour: A structural equation model

“…On the one hand, there is some evidence that Type A behaviour is not really very toxic and that it does not necessarily lead to CHD (Ben-Zur, 2002;Dembroski & Costa, 1988;Dembroski, MacDougall, Costa & Grandits, 1989;Haynes & Matthews, 1988;Huysamen, 1994;Lutz, Holmes & Cramer 1987;Williams, Barefoot, Haney & Harrell, 1988).…”

Relationship between natural killer activity and anger expression in patients with coronary heart disease

“…n.s., no significant Means, mean NK activity of patients with CHD split by the presence of each risk factor hostility, and angiographically documented coronary atherosclerosis, 15 or reported a relationship between the hostility scale in the Minesota Multiphasic Personality Inventory (MMPI) and mortality rates from arteriosclerosis and CHD. 16 Thus, anger and aggressiveness are considered to be important factors in the development of coronary arteriosclerosis and CHD.…”

“…[11][12][13][14] However, in the 1980s an increased number of studies indicated that anger and hostility were directly related to CHD. 15,16 Thus, TABP, as initially conceptualized, is a broad behavioral and emotional syndrome, but anger or hostility is more strongly correlated with CHD than the other aspects of TABP. Hostility is also related to atherosclerosis independently of TABP.…”