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Is Type A Behavior Really a Trigger for Coronary Heart Disease Events?

From the Department of Epidemiology (J.E.J.G., P.C.E.), Statistics and Public Health, University of Wales College of Medicine, Cardiff; Department of Epidemiology and Public Health (P.M.S., J.W.G.Y.), Queens University, Belfast; and Department of Psychiatry (S.A.S.), Queen Mary College, London

Address reprint requests to: Dr JEJ Gallacher, Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN UK. Email: Gallacher{at}cf.ac.uk

OBJECTIVE: The purpose of this study was to compare chronic with acute mechanisms by which Type A might predict incident coronary heart disease (CHD).

METHOD: The study included 2394 men aged 50 to 64 years who were assessed for CHD, Type A behavior, and CHD risk factors. Type A was assessed using the Jenkins Activity Survey (JAS), the Bortner scale, and the Framingham scale. Further examinations were completed at 5 and 9 years for incident CHD.

RESULTS: After 9 years, there was no increased risk of CHD associated with any Type A score. Nevertheless, high Bortner scores were associated with increased risk of incident CHD at 5 years and high JAS and Bortner scores were associated with a decreased risk between 5 and 9 years. Further analysis of Type A scores on time to first coronary event found strong inverse associations for all type A scores (JAS = 205 -0.49 months to first event, 95% CI = -0.20, -0.78, p = .001) (Bortner = 176 -0.27 months; 95% CI = -0.10, -0.44; p = .002) (Framingham = 0.44 -0.0011 months; 95% CI = -0.0002, -0.0019; p = .01).

CONCLUSIONS: The data show Type A is a strong predictor of when incident coronary heart disease (or coronary event) will occur rather than if it will occur. These findings suggest that Type A increases exposure to potential triggers, rather than materially affecting the process of atherosclerosis.

Key Words: coronary disease • Type A behavior • trigger hypothesis • atherosclerosis • stress • psychosocial factors

Abbreviations: CHD = coronary heart disease;; ECG = electrocardiogram;; JAS scale = Jenkins Activity Survey scale;; WHO = World Health Organization;; MI = myocardial infarction;

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