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Type A behavior and angiographically documented coronary atherosclerosis in a sample of 2,289 patients
R B Williams1, J C Barefoot, T L Haney
1Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Type A behavior pattern is linked to more severe coronary artery disease (CAD) in younger patients, but not older ones. This association, assessed by structured interview, suggests Type A behavior may contribute to CAD development in younger individuals.
Area of Science:
- Cardiology
- Behavioral Medicine
- Psychosocial Factors in Health
Background:
- The Type A behavior pattern, characterized by competitiveness and hostility, has been investigated for its role in cardiovascular disease.
- Previous studies have yielded conflicting results regarding the association between Type A behavior and coronary atherosclerosis (CAD).
Purpose of the Study:
- To investigate the relationship between Type A behavior pattern and the severity of angiographically documented coronary atherosclerosis (CAD).
- To examine how age modifies the association between Type A behavior and CAD severity.
Main Methods:
- Analysis of risk factor, behavioral, and angiographic data from 2,289 patients undergoing coronary angiography.
- Multivariable ordinal logistic regression was used to assess the association between Type A behavior (assessed by structured interview) and CAD severity, controlling for covariates.
- The Type A behavior pattern was also assessed using the Jenkins Activity Survey for comparison.
Main Results:
- Type A behavior, assessed by structured interview, was significantly associated with more severe CAD in patients aged 45 or younger.
- No significant association was found between Type A behavior and CAD severity in patients aged 46-54.
- A trend toward more severe CAD among Type B individuals was observed in patients aged 55 and older.
- Type A behavior assessed by the Jenkins Activity Survey showed no relation to CAD severity.
Conclusions:
- Structured interview-assessed Type A behavior is associated with more severe CAD in younger patients undergoing diagnostic coronary angiography.
- The observed reversal of the association in older patients may be attributed to survival effects.
- Future research should focus on hostility and anger components of Type A behavior, particularly in younger populations, to clarify its role in CAD pathogenesis.
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.