Personality and heart disease
Older studies suggested that there was a connection between the Type A personality type and heart disease, but subsequent research has. J Fla Med Assoc. Sep;77(9) Relationship between Type A personality and coronary heart disease. Analysis of five cohort studies. Schwalbe FC(1). The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial.
The methodology of the WCGS study, including the Structured Interview SI for assessing behavior patterns, was described in my first follow-up paper . Later site visits led to grant extensions for long-term follow-up, largely due to the efforts of the remarkable Dr. We became good friends many years later through your annual Congress and other activities of the American Institute of Stress. What finally convinced you that certain behavioral traits could increase risk for a heart attack?
We increasingly observed certain behaviors in our coronary patients, then mainly males. When asked what they thought caused their heart problems, diet or cholesterol were rarely mentioned. Sociocultural influences and job stress topped the list.
We also quizzed their wives and co-workers about this and certain behaviors and were surprised at how often their assessment was the same. The cluster of behaviors that emerged from these sources was far more common in males than females and it was also evident that the increased incidence of coronary disease had occurred mainly in men without any culpable changes of diet or prevalence of diabetes, hypertension or other risk factors.
Nor could the latter explain large geographic differences in coronary disease across North vs. South Europe and elsewhere. Even when combined, the standard Framingham coronary risk factors accounted for only about one third of coronary disease patients in prospective studies. It became clear that these risk factors were only markers that might predict coronary events but did not cause them. They did not explain the striking geographic differences in prevalence and incidence of coronary disease in diverse populations with identical risk factor levels.
As explained elsewhere, it seemed clear that additional factors should be considered . In revisiting my graciously inscribed dog-eared copy of your 30 year-old best seller, I have the feeling that time urgency impressed you the most. What other traits were considered to be key indicators? Mike and I differed about this. Competitive characteristics emerged for me as the cardinal Type A behavior.
Yes and No would probably be the safest answer. This requires some explanation. We observed and described certain behaviors that coexisted, although these varied in severity in different individuals.
Type A and B Personality
This became the Type A behavior pattern and its relative absence was designated as Type B behavior pattern. We later realized that Type B was not only a relative absence of Type A behaviors, but also a different way of viewing and responding to stressors. The large scale Western Collaborative Group Study showed a strong relationship between Type A behavior pattern and coronary heart disease that could not be explained by association with any single or combination of standard risk factors and was just as powerful a predictor.
They also avoided upsetting subjects. The Structured Interview assessment approach that we used was entirely different. Although Type A is a global constellation of highly inter-related behaviors, one Type A behavior may underlie most of the others and thus represents the dominant coronary-prone behavior for that particular individual.
After five decades of observation, I personally believe that the most important trait is constant and often inappropriate competitive behavior. Do you still believe self-report instruments are inadequate for measuring Type A traits? Has any progress been made in these or other Type A assessment approaches since then?
Self-reports fail to capture these because of inherent bias on self-appraisal and poor self-insight. Moreover, they poorly capture the stylistics and psychomotor behaviors that are essential to the construct of Type A and its assessment.
Unfortunately, self-report questionnaires were rarely validated by those who use them in so many published Type A studies and this has led to considerable confusion in this field.
Such self-report measures assess different behavioral characteristics and individual perception of attitudes, attributes, and activities, but exhibit only modest correlation among themselves or with SI results.
Aside from content-dependent items, important psychological differences limit their use across different cultures and populations. Type A was considered to be an adult male behavior but time urgency, hostility and competitiveness seem to have increased in women and even young children.
What factors have contributed to this? I am no authority. Children have always been more or less Type A or Bperhaps most apparent in their pace of activities and competitiveness . Frankenhaeuser noted increasing similarity between younger boys and girls studied over many decades and I believe that Type A behavior is more prevalent in all ages in Western societies as an American urban pace of life was adopted. There seems little doubt that women became more Type A in the U.
Terms like free-floating hostility, cynical mistrust and the like seem to be used simplistically, without either definition or validation.
It is amusing to see so many studies quoting each other, albeit none defining what they are talking about. This may be a pathway through which the relationship between type D personality and cardiovascular morbidity could be explained.
This kind of study is critical for a fuller understanding of the influence of personality on cardiovascular outcomes and, also, for the development of practical intervention strategies that aim to reduce the excess risk conferred by type D characteristics. In the case of heart failure, it may be that patients with type D personality require more detailed information about the consequences of ignoring symptoms and encouragement or guidance with consultation behaviour after the onset of symptoms.
Personality and heart disease
Another avenue for future research would be to attempt to change potentially damaging behaviour patterns, as has been attempted for type D individuals with CHD. There has been vigorous debate among psychosocial researchers about the validity and usefulness of the type D construct.
The second question is whether type D is really a stable personality type rather than a response to illness, since, in most studies, it is assessed in patients with diagnosed cardiovascular disease; perhaps the knowledge of having a serious illness affects people's moods and confidence in social interactions. More broadly, we need to understand better the interpersonal context of individual characteristics such as type D.
Type A and Coronary Disease Part 1 – The American Institute of Stress
Petticrew in collaboration with the other authors. All authors contributed to the interpretation of the data and to the preparation and writing of the article, and contributed to and approved the final version. Accepted March 21, We analyzed tobacco industry documents to show that the tobacco industry was a major funder of TABP research, with selected results used to counter concerns regarding tobacco and health.
Our findings also help explain inconsistencies in the findings of epidemiological studies of TABP, in particular the phenomenon of initially promising results followed by negative findings. Subsequent studies also have shown no association with mortality: It is now well documented that the industry has sought over many decades to undermine the scientific evidence on smoking and health. This initial search identified documents, and from those we identified a subset of 66 tobacco industry documents on TABP research.
It involved providing substantial funding to key researchers in the field, including supporting a university chair. Early Industry Interest in Type A Behavior Tobacco industry interest in type A behavior was early and prolonged, and involved very significant funding to key researchers in the field.
It seems probable that heavy cigarette smokers have more clinical coronary artery disease than non-smokers. Does this mean that excess nicotine is responsible?
Or does it mean that persons exhibiting the behavior pattern I described above tend to smoke more? In other words, are we mistaking a concomitant for a cause?
I am positive we are. This is America today—the pace fast, the competition great.
- Type A and Type B personality theory
- Type A Behavior Pattern and Coronary Heart Disease: Philip Morris’s “Crown Jewel”
We live with more tension, more emotion, more concern about our health, more everything than ever before. In our type of socioeconomic environment, if you want to achieve more and you have more obstructions, traffic, persons, things, what do you do today? Well, either you become more frustrated—or you hurry. I would sum up what we have found here that smoking does not seem to cause heart disease…. It was argued that the causes of cancer were deemed to be multifactorial, with psychological stress being a key contributing factor.
One of the most important studies to investigate the role of TABP was the Recurrent Coronary Prevention Project, a 5-year trial to alter type A behavior in post—myocardial infarction patients to reduce the recurrence of acute cardiac events. It is very valuable to the cigarette defense to establish firmly that unsuccessfully managed stress plays a dominating role in the etiology of cancer. Additionally, success for the Friedman project will have a strong tendency to discredit the major prospective mortality studies that appear to indict smoking but fail to discover, and adjust for, a very large effect on mortality from negative mental states.
Friedman about the issue of smoking and health. RJ Reynolds supported a wide range of scientific activities related to the subject, including research on psychological predictors of myocardial infarction at Yale University. This review committee was made up of RJ Reynolds grantees Paul Black of Boston University, 72 Stevo Julius of the University of Michigan, who had industry funding for a study on personality and risk of hypertension, 73 and Rosenman; it was advised by tobacco industry consultants Alvan Feinstein of Yale University, a prominent epidemiologist, 74,75 and medical toxicologist Leon Goldberg of Duke University.
His letter supported the industry claim that the scientific evidence remained unreliable. He argued, first, that only 5 of 11 studies were statistically significant; second, that they were observational; and third, that they did not control for a significant confounder, type A behavior. In fact, by this date TABP itself had been shown to be a significant predictor of CHD in only 3 of 12 studies, themselves all observational studies.
The assumption is that we remain vulnerable unless we can break down the near unanimity in the medical research community that cigarette smoking causes several hundred thousand premature deaths a year in the United States alone….
This leads me smoothly, I hope, to our external funding which is aimed, almost entirely, at promoting the role of psychosocial stresses in mortality.
This seems by far the most promising area for us at this time…. There is a special reason why we should go ahead quickly and quietly. The climate for acceptance of tobacco money by research institutions is worsening…. I believe we would be wise to keep a low profile after the grants were made. The effect measured … may be caused by stress rather than by passive exposure to cigarette smoke. There is considerable evidence that psychologic stress is capable of increasing the risk of developing diseases that are major causes of death.
Both Type A behavior and high levels of hostility have been shown in prospective studies of human populations to predict increased risk of coronary heart disease and death due to all causes…. The most recent systematic review of studies of type A behavior and CHD shows clearly the limited role played by type A behavior in the etiology or prognosis of CHD. Moreover, 3 of the 4 etiologic studies with positive findings had a direct or indirect link to the tobacco industry.
It has previously been shown that the concept of psychosocial stress, as a supposed cause of cancer and CHD, was used in litigation by the industry to defend its interests. The Meyer Friedman Institute last filed Internal Revenue Service records inalthough it appears to be still in existence.
By the early s, the few early positive findings were being outweighed by numerous negative studies, and TABP and hostility have rarely been shown to be implicated in either the etiology or the prognosis of CHD. Although we have focused on TABP, other documents indicate that the industry was engaged in a much wider quest to identify psychological factors that may affect diseases known to be associated with smoking. This analysis shows the extent to which the tobacco industry has shaped major themes in contemporary public health research.
Even when scientific evidence is lacking, the industry has proved expert at exploiting thin evidence for its own purposes, using concepts that appeal to popular thinking. Acknowledgments When the project was initiated, M. Human Participant Protection No institutional review board approval was required because all data were obtained from secondary sources documents.
Friedman M, Ulmer D. Michael Joseph; 2. Coronary heart disease in the Western Collaborative Group Study: Predictions of clinical coronary heart disease by a test for the coronary prone behavior pattern.