Feasibility of altering type A behavior pattern after myocardial infarction. Recurrent Coronary Prevention Project Study: methods, baseline results and preliminary findings.

Abstract

SUMMARY We studied 1035 consecutive postinfarction patients to determine the feasibility of altering type A behavior and the effect such alteration might have on subsequent rates of infarction and cardiovascular death. Approximately 300 subjects were enrolled in small groups and primarily received cardiologic counseling on the usually accepted coronary risk factors. Six hundred subjects received, in addition to cardiologic counseling, advice and instructions designed to diminish the intensity of their type A behavior. The remaining subjects, serving as controls, received no counseling, but were examined and interviewed annually, as were those who dropped out of counseling groups. More than 98% of the 1035 subjects exhibited moderate-to-severe type A behavior during a videotaped structured interview.After the first year of this 5-year study, the rates of infarction and cardiovascular death were lower (p < 0.01 and p< 0.05, respectively) among subjects who received both cardiologic and behavioral counseling than among the control subjects. The rate of nonfatal infarction was lower (p < 0.05) among subjects who received behavioral counseling than among those who received only cardiologic counseling or those who dropped out of either counseling group.The circumstances that most often preceded recurrent infarction or cardiovascular death were emotional crisis, excess physical activity, ingestion of a single fatty meal or a combination of these phenomena.PERSONS who exhibit chronic type A behavior, an emotional syndrome characterized by a continously harassing sense of time urgency and easily aroused hostility, were shown, in 1959, to exhibit a sevenfold greater prevalence of clinical coronary heart disease (CHD) than persons who exhibit type B behavior (absence of a chronic sense of time urgency and easily aroused or "free-floating" hostility). Subsequent lab-

Type A personality and mortality: Competitiveness but not speed is associated with increased risk

“…Furthermore, it was shown that the clinical outcome of CHD was improved in patients undergoing behavioral counseling (7,8).…”

Type a behaviour pattern as a risk factor after myocardial infarction: A review

“…An interviewer notes the content of a participant's responses to 28 questions and records specific psychomotor and physiologic manifestations diagnostic of type A behavior. Scores for sense of time urgency (scale T; 27 items) and free-floating hostility (scale H; 12 items), as well as a total score, are obtained from a check-list (Friedman et al, 1982).…”

Can the Type A Behavior Pattern be Altered after Myocardial Infarction? A Second Year Report from the Recurrent Coronary Prevention Project

“…The methods employed for the recruitment, enrollment, initial examination, and treatment of 1012 volunteer postinfarction patients in the San Francisco Bay area have been described elsewhere (11). Briefly summarized, eligible individuals were under the age of 65, had suffered a documented acute myocardial infarction at least six months before entry, were not currently smoking, and had never been treated for or exhibited signs of diabetes.…”

“…The design and first-year results of this investigation have been reported elsewhere (11). The purpose of this article is to introduce a technology for assessing reduction in the TABP, and to document our progress in altering it after two years of treatment.…”