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

Abstract

Ten studies, involving a total of 5826 patients, on type A and post-infarct morbidity/mortality are reviewed. Persons who were assessed to be type A before or shortly after infarction appear not to be at greater risk for death or recurrent cardiac morbidity in the first years subsequent to infarction. In fact they may enjoy lower risk. Persons who show large reductions in type A behaviour likely suffer fewer cardiac recurrences than those who do not. A conceptualization of type A as a modifiable cardiac risk factor which people are inclined to lessen after suffering infarction, is consonant with the findings. An intriguing finding that type A MI-survivors have a greater risk for sudden cardiac death than do non-type A persons awaits replication.KEY WORDS: Coronary disease; myocardial infarction; prospective studies; review; risk factors; type A personality.Research on the role of psychological factors on the incidence of myocardial infarction (MI) has a considerable tradition. The type A Behaviour Pattern (TABP) is probably the most well known psychological risk factor for MI. Type A behaviour is characterized by a relatively high level of ambitiousness, aggressiveness, hostility and competitive drive and a chronic sense of time urgency. The relative absence of these characteristics is labelled type B behaviour. Friedman and Rosenman (1974) defined type A behaviour as an emotional syndrome characterized by a sense of time urgency and easily aroused hostility. Type A behaviour was implicated as a possible risk factor for coronary heart disease (CHD) in the Western Collaborative Group Study (Rosenman and colleagues, 1964;1975;1976). During 8.5 years of follow-up, type A men had CHD at approximately twice the rate of type B men. A number of studies supported this finding (e.g.

A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators

“…Various studies have found that hostility and anger-in successfully predicted the incidence of a variety of manifestations of CVD, including CHD and HYP [ 7 , 24 , 26 , 28 , 31 – 33 ). Although many subsequent studies, reviews and meta-analyses concluded that Type A personality was not a valid indicator of cardiac prognosis or hard endpoints in CVDs [ 29 , 34 – 38 ], some researchers have suggested that this personality pattern may suffered a premature demise. Recent research has shown that interventions for Type A personality improved depression in CHD patients [ 39 – 40 ].…”

Psychosocial risk factors and coronary heart disease

“…Recently, a review of ten studies about Type A behavior after myocardial infarction (Cohen, Ardjoen & Sewpersad, 1997) found that Type A, assessed either before or just after MI did not predict death or recurrent cardiac morbidity. This may have been due to the fact that Type A behavior shows a decline in heart patients after their cardiac event both in treated and non-treated groups but significantly more in the treated groups (Friedman, Fleishman & Price, 19%;Burrell, 19%;Sebregts, Falger, Bar, & Appels, 1999).…”