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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.

The purpose of this study was to determine the effects of Type A behavior and family history of hypertension on cardiovascular reactivity to mental stress in a group of employed black women. Measures of heart rate and of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken at rest, during a mental arithmetic task, and during the Type A Structured Interview (SI). Results indicated that the Type A behavior pattern was associated with SBP and DBP hyperresponsivity during the SI but not during mental arithmetic. Additionally, certain speech components of the Type A pattern, as well as features of the potential-for-hostility component, were also related to cardiovascular responses during the SI. Family history of hypertension did not influence the cardiovascular parameters either alone or in combination with Type A behavior. The results suggest that many of the cardiovascular response characteristics of the Type A pattern that have been observed in predominantly white samples also hold true for blacks. Replication of these findings with other subgroups of blacks, such as young females and middle-aged males, will help document the generality of these findings within the black population.

This study reports the development of a brief self-report measure of the Type A behavior pattern based upon a set of adjectives derived from the Gough Adjective Checklist (ACL). Previous work from our laboratory established a set of adjectives identified by experts as being relevant to the Type A construct that subsequently was found to successfully distinguish Type A individuals from their Type B counterparts. In the present study, a Type A self-rating scale based on these adjectives was found to be significantly related to an established Type A self-report instrument, the Jenkins Activity Survey (JAS), and to an independent behavioral rating based upon a standard structured interview (SI). However, no measure of Type A was related to the severity of coronary artery disease (CAD) as documented by coronary angiography. The advantages and disadvantages of the various Type A measures are discussed in the context of their ability to identify individuals at risk for the development of CAD.

Beta-adrenergic sympathetic nervous system (SNS) hyperresponsivity to behavioral stress may play a role in the onset of sustained high blood pressure--particularly in persons with a parental history of hypertension. Although hypertension is extremely prevalent among blacks, the association between parental history of hypertension and cardiovascular hyperresponsivity has not been explored in this group. The present study examined the influence of parental history of hypertension on cardiovascular stress reactivity in a group of young black females. Contrary to previous findings with whites, black subjects with a parental history of hypertension exhibited significantly smaller systolic blood pressure and forearm blood flow increases, and moderately smaller diastolic blood pressure increases to the task. Parental history subjects also exhibited slower heart rates throughout each experimental condition. The results suggest that blacks at risk from hypertension may not exhibit the beta-adrenergic hyperresponsivity to behavioral stress observed in whites. These results may suggest that beta-adrenergically mediated hyperresponsivity may be less involved in the development of hypertension among blacks.

The Cook-Medley Hostility (Ho) scale (Cook & Medley, 1954) has been associated with increased risk for coronary heart disease (CHD). There is relatively little information about the psychosocial correlates of the Ho scale in clinical or adult populations, however. In this study, 132 patients (mean age = 53 years) referred for diagnostic coronary angiography completed a battery of self-report questionnaires including the Minnesota Multiphasic Personality Inventory (MMPI), Hopkins Symptom Check List (SCL-90), State-Trait Personality Inventory (STPI), Type A Self-Rating Inventory (TASRI), and Perceived Social Support Scale (PSSS). Examination of the pattern of correlations among the Ho scale and the psychometric instruments revealed that the Ho scale may be viewed as tapping four general behavioural dimensions including anger and hostility, neuroticism, social maladjustment and ineffective coping style. These findings serve to further understanding about the psychological dimensions of hostility as measured by the Cook-Medley Ho scale.

This study examined the interaction of race and parental history of hypertension on patterns of cardiovascular responses among women. Two stressors were used that produce different patterns of cardiovascular reactivity: mental arithmetic, primarily a beta-adrenergic stimulus, and the cold face stimulus, which evokes alpha-adrenergic (i.e. vascular) activity. Systolic and diastolic blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were assessed before, during, and after arithmetic and cold face stimulus. Both tasks produced the expected patterns of cardiovascular adjustment, although no Black-White differences occurred during arithmetic. However, Black subjects did show a slower recovery of diastolic blood pressure following arithmetic. The cold face stimulus produced significantly greater changes in systolic blood pressure in the Black than in the White women. Parental history of hypertension did not relate significantly to reactivity. The results provide limited support for the idea that Black females exhibit a greater pressor response than White females to a stimulus that produces primarily vascular rather than cardiac changes. These findings are discussed in relation to previous findings with males and with respect to their implications for the role of reactivity in Black-White differences in hypertension prevalence.

Qualitatively distinct patterns of cardiovascular and neuroendocrine responses were observed in male college students during mental work and during sensory intake task performance. During mental work, Type A (coronary-prone) subjects showed greater muscle vasodilatation and more enhanced secretion of norepinephrine, epinephrine, and cortisol than Type B subjects. During sensory intake, Type A hyperresponsivity was found for testosterone and, among those subjects with a positive family history of hypertension, for cortisol. As a demonstration of combined cardiovascular, sympathetic nervous system, and neuroendocrine hyperresponsivity to specific cognitive tasks in Type A subjects, this study breaks ground in the search for mechanisms mediating the increased coronary disease risk among Type A persons.

Factor analysis of responses from 1002 men and women were used to define two subscales of the Cook and Medley Hostility Scale. Both the Cynicism and the Paranoid Alienation subscale described attitudes of mistrust and alienation, and both were correlated with MMPI factors measuring aspects of psychopathology. It was suggested that measures of the broader domain of Agreeableness-Antagonism be examined as possible predictors of CHD.

beta-Adrenergic hyperreactivity has been proposed as a pathogenic mechanism of increased coronary risk in Type A individuals. This study compared the effects of propranolol, diazepam, and placebo on cardiovascular and neuroendocrine responses to a stressful cognitive task in six young Type A males. Although diazepam did not differ from placebo, propranolol attenuated heart rate and norepinephrine responses and enhanced cortisol responses to the task. Findings suggest that propranolol has reciprocal effects on the norepinephrine and cortisol components of the "fight-flight" response. Possible central nervous system mechanisms are described.

This article reviews the epidemiologic evidence linking psychological factors and various indexes of coronary heart disease (CHD) that has been gathered since the Amelia Island Conference in 1978. In general, studies of populations not selected according to CHD risk support the conclusion that the global type A construct is predictive of increased risk of coronary events. In high-risk groups, including patients undergoing coronary angiography, the evidence with respect to global type A is much less clear. This stems from the fact that most of these studies, although generally failing to find statistically significant relationships between coronary events and type A behavior, are flawed in a number of ways, including inadequate statistical power of results, use of less than adequate instruments, and failure to take an apparent interaction between type A behavior and age into account. Nevertheless, taken together, these findings suggest that it may be possible to identify measures of coronary-prone behavior that are more powerful than the global type A measure. Extensive evidence suggests that such measures may be found in the domain of hostility and anger. Measures of hostility and anger coping styles have been found to be associated with coronary atherosclerosis in populations in which global type A was not related to disease, and measures of hostility have predicted increased coronary events and total mortality in prospective population samples followed for from 20 to 25 years. Preliminary evidence suggests that hostility/anger characteristics may account for the increased coronary risk associated with global type A behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Previous research has demonstrated a fall in systolic blood pressure in the rat measured 2--5 min following shock-induced fighting. This blood pressure fall appears to depend on intact CNS catecholamine neurons. The locus coeruleus is known to supply noradrenergic neuron terminals to much of the brain. In this study, we attempted to identify the location of the CNS catecholamine neurons mediating the blood pressure response to fighting by studying the blood pressure response to shock-induced fighting in locus coeruleus-lesioned and shamlesioned rats. The locus coeruleus-lesioned animals showed a blood pressure increase after fighting on the average across 2 days of testing, while sham-lesioned animals showed a blood pressure decrease after fighting. The difference between the blood pressure responses of the two groups was highly reliable. Since both histofluorescence and biochemical studies indicated that CNS norepinephrine levels were decreased in lesioned as compared to control animals, the findings are interpreted as showing that noradrenergic neurons originating in the locus coeruleus play an important role in mediating aspects of the relationship between fighting behavior and blood pressure response.