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Type A behavior and survival: a follow-up study of 1,467 patients with coronary artery disease
J C Barefoot1, B L Peterson, F E Harrell
1Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Type A behavior in coronary artery disease patients correlated with better survival among those with poor left ventricular function. This behavior pattern did not predict nonfatal heart attacks.
Area of Science:
- Cardiology
- Behavioral Medicine
- Psychosocial Factors in Disease
Background:
- Coronary artery disease (CAD) is a leading cause of mortality.
- The role of behavioral patterns, such as Type A behavior, in cardiovascular outcomes requires further investigation.
- Previous studies suggest a link between Type A behavior and CAD, but its impact on survival in relation to disease severity is less clear.
Purpose of the Study:
- To examine the relationship between Type A behavior pattern and survival in patients with documented coronary artery disease.
- To investigate whether Type A behavior modifies the prognosis of CAD based on disease severity.
- To determine if Type A behavior predicts the incidence of nonfatal myocardial infarctions.
Main Methods:
- Prospective cohort study of patients admitted to Duke Medical Center between 1974 and 1980 with documented CAD.
- Assessment of Type A behavior pattern using established methods.
- Follow-up until 1984 with data collection on cardiovascular events and survival.
- Statistical analysis using Cox regression models, controlling for coronary angiography data to assess disease severity and left ventricular function.
Main Results:
- A significant interaction (p < 0.01) was found between Type A behavior and disease severity in predicting cardiovascular death.
- Among patients with poor left ventricular function, Type A individuals exhibited better survival rates compared to Type B individuals.
- No significant association was observed between Type A behavior and the incidence of nonfatal myocardial infarctions.
Conclusions:
- Type A behavior may be associated with differential survival in CAD patients, particularly those with compromised left ventricular function.
- The findings suggest that Type A behavior might act as a risk modifier for cardiovascular mortality in specific subgroups of CAD patients.
- These results do not preclude a role for Type A behavior in the pathogenesis of coronary artery disease.
Abstract:
Patients with documented coronary artery disease, admitted to Duke Medical Center between 1974 and 1980, were assessed for type A behavior pattern and were followed until 1984. The relation of type A behavior to survival was tested using data from coronary angiography to control for disease severity. Cox model regression analyses demonstrated an interaction (p less than 0.01) between type A behavior and an index of disease severity in the prediction of cardiovascular death. Among those with relatively poor left ventricular function, type A patients had better survival than type B. This difference was not present among patients with better prognoses. Type A behavior did not predict the subsequent incidence of nonfatal myocardial infarctions. Differential risk modification and differential selection into postinfarction status are possible explanations for the findings. These results need not conflict with the proposition that type A behavior plays a role in the pathogenesis of coronary artery disease.