Type A behavior pattern and coronary disease risk. Update and critical evaluation.
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Biomedical subjects
Publications and source records attributed to S G Haynes.
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Components of fat and their relationship to total energy are described for 2,368 white male and 2,200 white female adults, aged 20-59 years, for whom 24-hour dietary recalls were completed between 1972 and 1975 in nine North American populations as a part of the Lipid Research Clinics (LRC) Program Prevalence Study. Men had higher absolute intakes of total fat and cholesterol than women, although both sexes consumed diets similar in relative composition of polyunsaturated, saturated, and monounsaturated fatty acids. Marked geographical differences in intakes of energy, total fat, and dietary cholesterol were observed. Compared with data from dietary surveys conducted in the 1960's the LRC data showed that consumption of cholesterol had decreased by the early 1970's, whereas consumption of polyunsaturated fatty acids appears to have increased, resulting in a higher ratio of polyunsaturated to saturated fatty acids. However, comparison of current dietary guidelines with these data, which are based on a single dietary recall, showed that few LRC participants met the recommendations of the Senate Select Committee on Nutrition and Human needs for dietary fat intake.
Mean energy intake and its components are presented for 4,568 white adults, 20-59 years, who participated in a population survey at nine North American Lipid Research Clinics (LRC). Nutrient intake was evaluated by a 24-hour dietary recall. Mean energy intakes ranged from 3200 kcal at age 20 to 2400 kcal at age 59 for men (2150-1650 for women). Protein intake, about 15% of energy intake, exceeded 1 g/kg body weight at all ages. Carbohydrate intake was about 40-45% of kcal, starch provided 14-20%, and estimated sucrose intake provided about 6-14%. Sex- and age-related differences varied for each macronutrient. Mean alcohol intake, for those reporting alcohol consumption, contributed 6-18% of energy for women, and 8-15% for men. Comparisons are made with data from the Health and Nutrition Examination Survey I and from the USDA Nationwide Food Consumption Survey, with the Recommended Dietary Dietary Allowances, and with the Dietary Goals.
The relationship between physical disability and cardiovascular risk factors among persons free of diagnosed cardiovascular disease was examined. Between 1948 and 1951, a cohort of adult, Framingham, Massachusetts, residents was assembled for a longitudinal examination of cardiovascular disease. Twenty-seven years after the participants' initial examination (between 1976 and 1978), members of the cohort who were still participating in the Framingham Heart Study were interviewed to ascertain their self-assessed ability to perform various physical activities. A score on the cumulative disability index was assigned to 2,021 persons free of diagnosed cardiovascular disease. Analyses controlled for noncardiovascular health conditions which were identified as related to disability. Among women, both long-term and current hypertension and body mass index, as well as diabetes, were associated with disability. Among men, long-term hypertension was related to disability. Age-specific analyses indicated that, for women, current hypertension was statistically significantly related to disability in the middle and oldest age groups; long-term hypertension was related to disability in the middle age group. Both long-term and current measures of diabetes in the oldest age group and long-term measure of cigarette use in the middle age group of women were also related to disability. Age-specific analyses among men indicated that the only statistically significant risk factor was long-term hypertension in the youngest age group. Cholesterol was not related to disability. Results suggest that certain cardiovascular risk factors should be considered in efforts to understand further the development of disability.
The relationship of social status and behavior type to the incidence of coronary heart disease was examined among husbands and wives in the Framingham Heart Study. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. Men married to women with 13 or more years of education were 2.6 times more likely to develop coronary disease than men married to women with a grammar school education (95% CI = 1.0-6.9). Incidence rates among husbands married to women employed outside the home were similar to rates among men married to housewives (15.1 vs. 16.1%, respectively). However, men married to women employed in white-collar jobs were over three times more likely to develop heart disease than those married to clerical workers, blue-collar workers, or to housewives (RR = 4.0, 5.4, and 2.9, respectively; p less than or equal to 0.004). The increased risk in husbands married to women educated beyond the high school level was observed only among men married to women employed outside the home. These effects were apparent regardless of the husband's social status or standard coronary risk factors. Further exploration of these associations revealed that higher-educated working wives whose husbands developed coronary heart disease were significantly more likely to have had a nonsupportive boss and fewer job promotions than wives of noncases.
Analyses of spouse data from the Framingham Heart Study indicated that the risk of developing coronary heart disease among Type A men, compared with Type B men, was modified by the behavior or social status of their wives. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. When Type A and Type B men were stratified by the social and personality characteristics of their wives, it was found that the differential rate of heart disease between Type A and Type B men was present only in situations where the wives' characteristics might be deemed stressful. Type A husbands were 2.5 times as likely to develop coronary heart disease as Type B husbands if married to women with 13 or more years of education, and had 3.5 times the coronary risk of Type B husbands if married to a woman employed outside the home. When spouses were stratified by behavior type, employed outside the home. When spouses were stratified by behavior type, the highest rates of coronary heart disease were among Type A men married to Type B wives (25%). This rate was over three times the rate among Type B men married to Type B wives (7.8%). When tests for interaction between the behavior type of husbands and characteristics of wives were calculated, significant effects were found among blue-collar men on all variables except wives' educational level. This indicates that Type A men in white-collar occupations are at higher risk of heart disease regardless of wives' characteristics; whereas, the effect of behavior type among men in blue-collar occupations was interrelated with and modified by wives' characteristics. These results were apparent regardless of the husbands' standard coronary risk factors.
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This study explored the association between Type A behavior, as measured by a short questionnaire on time urgency and competitiveness, and the development of coronary heart disease (CHD). An assessment of Type A behavior in 750 women and 580 men, aged 45-64 years, participating in the Framingham Heart Study, took place between 1965 and 1969. Type A behavior was associated with a two-fold risk of developing CHD over the ensuing 10 years. Among all women, the relative risk (RR) was 2.0 with confidence limits = 1.2 to 3.3. Among housewives, CHD incidence rates were 2.5 times greater among Type A's compared to Type B's (p = 0.02). Type A working women were more than 1.5 times as likely to develop CHD as Type B's, although this was not significant at the 10 year follow-up. Among men employed in white-collar jobs, the RR was 2.4 with confidence limits = 1.1 to 5.7. Type A behavior was most strongly related to coronary diagnoses in which angina pectoris symptoms were present. Synergism between Type A behavior and other CHD risk factors is demonstrated. The findings suggest that assessment of Type A behavior can improve the prediction of incident coronary cases, independent of the standard coronary risk factors.
An extensive psychosocial questionnaire was administered to 1674 coronary free individuals participating in the Framingham Heart Study between 1965 and 1967. The respondents were followed for the development of coronary heart disease (CHD) over an eight-year period. Women (aged 45-64 years) who developed CHD scored significantly higher on the Framingham Type A behavior, suppressed hostility (not showing or discussing anger), tension, and anxiety symptoms scales than women remaining free of CHD. Type A women developed twice as much CHD and three times as much angina as Type B women. In a multivariate analysis, Framingham Type A behavior and not discussing anger were independent predictors of CHD incidence when controlled for the standard coronary risk factors and other psychosocial scales. Men exhibiting Framingham Type A behavior, work overload, suppressed hostility (not showing anger), and frequent job promotions were at increased risk of developing CHD (especially in the age group 55-64 years). Among men aged 45-64 years, Type A behavior was associated with a twofold risk of angina, myocardial infarction, and CHD in general, as compared to Type B behavior. The association was found only among white-collar workers and was also independent of the standard coronary risk factors and other psychosocial scales. This prospective study suggests that Type A behavior and suppressed hostility may be involved in the pathogenesis of CHD in both men and women.
This study examined the relationship of employment status and employment-related behaviors to the incidence of coronary heart disease (CHD) in women. Between 1965 and 1967, a psychosocial questionnaire was administered to 350 housewives, 387 working women (women who had been employed outside the home over one-half their adult years), and 580 men participating in the Framingham Heart Study. The respondents were 45 to 64 years of age and were followed for the development of CHD over the ensuing eight years. Regardless of employment status, women reported significantly more symptoms of emotional distress than men. Working women and men were more likely to report Type A behavior, ambitiousness, and marital disagreements than were housewives; working women experienced more job mobility than men, and more daily stress and marital dissatisfaction than housewives or men. Working women did not have significantly higher incidence rates of CHD than housewives (7.8 vs 5.4 per cent, respectively). However, CHD rates were almost twice as great among women holding clerical jobs (10.6 per cent) as compared to housewives. The most significant predictors of CHD among clerical workers were: suppressed hostility, having a nonsupportive boss, and decreased job mobility. CHD rates were higher among working women who had ever married, especially among those who had raised three or more children. Among working women, clerical workers who had children and were married to blue collar workers were a highest risk of developing CHD (21.3 per cent).
This paper describes an epidemiological study of the patterns and correlates of survival after early (age 62 to 64) and normal retirement (age 65) among 3,971 U.S. rubber tire workers. For the two companies, death rates were significantly elevated during the first, fourth, and fifth years after early retirement. Among normal retirees, elevations in death rates occurred during the third or fourth years after retirement in Company B and Company A, respectively. When the experiences of both companies were combined, no significant mortality excesses were observed. Comparisons of deaths (cases) within 5 years of retirement with survivors (controls) showed that pre-retirement health status was the only significant predictor of survival after early retirement. Among normal retirees, lower status workers were more likely to die within 3 years of retirement than higher status workers, who were more prominent among deaths 4 to 5 years after retirement. Risks of dying were greater among normal retirees with a history of repeated medical and nonmedical absences.
Questionnaires administered to 1822 members of the Framingham Heart Study from 1965 to 1967 provided measures of personality type, sociocultural mobility, situational stress and somatic strain. Clusters of questions selected by a panel of experts, and verified by item and factor analysis, formed scales of Type A behavior and other psychosocial states. The Framingham Type A behavior scale was significantly correlated with daily stress (.47), emotional lability (.43), tension (.42), anger symptoms (.34), and ambitiousness (.31). Women were less likely than men to be ambitious and to exhibit the Framingham Type A behavior, and were more likely than men to be emotionally labile, tense, and to suppress hostility. Few consistent associations were found between psychosocial stress measures and levels of blood pressure or cholesterol. Social status and marital conflicts were significantly associated with patterns of smoking. The Framingham Type A behavior pattern and other psychosocial measures were not related to the level of CHD risk, as determined by the Framingham logistic equations.
In a cross-sectional study of 1822 persons aged 45 to 77 years of age, the association of 20 psychosocial scales with coronary heart disease (CHD) prevalence was assessed. Women (aged 45 to 64 years) with coronary disease scored significantly higher on the Framingham Type A behavior, emotional lability, aging worries, tension, and anger symptoms scales than women free of CHD. The prevalence of CHD was significantly higher among working women and housewives classified as Type A than as Type B behavior. Among men under 65 years, Framingham Type A behavior, aging worries, daily stress, and tension were associated with the prevalence of myocardial infarction (MI). For men and women over 65 years, marital dissatisfactions or disagreements were significantly related to the prevalence of CHD. In a multivariate analysis, the above associations were controlled for age, blood pressure, cholesterol, smoking, and other psychosocial scales. Among women under 65 years of age, Framingham Type A behavior and emotional lability remained significant discriminators of CHD prevalence. Aging worries significantly differentiated men under 65 with and without MI. Issues related to the interpretation of results from cross-sectional studies are discussed, and four hypotheses are suggested for future prospective work in this area.
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