Type A Behavior, Hostility, and Coronary Atherosclerosis*

Abstract

Type A behavior pattern was assessed using the structured interview and hostility level was assessed using a subscale of the Minnesota Multiphase Personality Inventory in 424 patients who underwent diagnostic coronary arteriography for suspected coronary heart disease. In contrast to non-Type A patients, a significantly greater proportion of Type A patients had at least one artery with a clinically significant occlusion of 75% or greater. In addition, only 48% of those patients with very low scores (less than or equal to 10) on the Hostility scale exhibited a significant occlusion; in contrast, patients in all groups scoring higher than 10 on the Hostility scale showed a 70% rate of significant disease. The essential difference between low and high scorers on the Hostility scale appears to consist of an unwillingness on the part of the low scorers to endorse items reflective of the attitude that others are bad, selfish, and exploitive. Multivariate analysis showed that both Type A behavior pattern and Hostility score are independently related to presence of atherosclerosis. In this analysis, however, Hostility score emerged as more related to presence of atherosclerosis than Type A behavior pattern. These findings confirm previous observations of increased coronary atherosclerosis among Type A patients. They suggest further that an attitudinal set reflective of hostility toward people in general is over and above that accounted for by Type A behavior pattern. These findings also suggest that interventions to reduce the contribution of behavioral patterns to coronary disease risk might profitably focus especially closely on reduction of anger and hostility.

Autonomic characteristics of defensive hostility: Reactivity and recovery to active and passive stressors

“…Hostile individuals have been described as creating a self-fulfilling prophecy by not only responding to everyday stressors with heightened physiological reactivity, but also reinforcing negative interactions with other people through cynical attitude, increasing the probability of subsequent stressful interactions (Smith & Pope, 1990). The Ho scale was found to provide a stronger association to severity of coronary artery disease (CAD) among patients undergoing coronary angiography than the association between Type A behavior assessments and CAD in the same sample (Williams et al, 1980). Numerous studies have established a relationship between the Ho scale and coronary dysfunction.…”

“…Since this study investigated coronary calcification in individuals 18-30 yrs of age, these results suggest that a high level of trait hostility may predispose young adults to CHD. Another study utilizing 424 angiography patients revealed that 70% of those with Ho scores above 10 had clinically significant CAD (Williams et al, 1980). One problem in reviewing studies that directly link the Ho scale to coronary pathology is the difficulty in determining direction of causality.…”

Anger and denial as predictors of cardiovascular reactivity in women

“…Hostility also has been linked to the severity of ooronary atherosolerosis (Williams, Haney, Lee, Kong, Blumenthal, & Whalen, 1980;Shekelle, Gale, Ostfeld, & Paul, 1983;Barefoot, Dahlstrin & Williams, 1983), although the differentiation between anger and hostility in the literature seldom has been clear. Cook & Medley (1954) (1979) found that men who scored high in denial, compared to those low in denial, showed marginally greater heart rate, increased spontaneous skin resistance and significantly greater frontalis region EMG.…”

“…Spielberger has described state anger as "an emotional state or condition that consists of subjective feelings of tension, annoyance, irritation, fury and rage, with concomitant activation or arousal of the autonomic nervous system" (Spielberger, 1988, The Cook-Medley Hostility (HO) Scale (Cook & Medley, 1954), a 50 item hostility inventory, has also been found frequently to be associated with coronary heart disease outcomes (e.g., Barefoot, Dahlstrom, & Williams, 1983, Williams et al, 1980Williams et al, 1985;Shekelle et al, 1983). It will also be utilized in an attempt to assess whether the factors it measures are similar to or different from those of the STAXI.…”

Tramiento cognitivo-conductual para enfermos cardiovasculares

“…Aunque para ser más exactos, deberíamos hablar del componente irahostilidad del PCTA (Barefoot et al, 1983;Dembroski et al, 1989;Hecker, Chesney, Black, & Frautschi, 1988;King, 1997;MacDougall, Dembroski, Dimsdale, & Hackett, 1985;Richter et al, 2011;Shekelle et al, 1983;Williams et al, 1980). En general, existe una gran confusión entre los términos ira y hostilidad, siendo éstos en ocasiones empleados como sinónimos, sin serlo; en el siguiente apartado, se detallará más a este respecto.…”