James M. MacDougall

Components of type A, hostility, and anger-in: relationship to angiographic findings

&NA; Previous research has linked the Type A coronary‐prone behavior pattern to angiographically documented severity of coronary atherosclerosis (CAD). The present study sought through component scoring of the Type A Structured Interview (SI) to determine what elements of the multidimensional Type A pattern are related to coronary disease severity in a selected group of patients with minimal or severe CAD. Multivariate analyses controlling for the major risk factors showed no relationship between global Type A and extent of disease. Of all attributes measured, only Potential for Hostility and Anger‐In were significantly and positively associated with the disease severity, including angina symptoms and number of myocardial infarctions. Further analysis revealed that Potential for Hostility and Anger‐In were interactive in their association, such that Potential for Hostility was associated with disease endpoints only for patients who were high on the Anger‐In dimension. These findings support previous research in suggesting that anger and hostility may be the critical aspects of the Type A pattern in predisposing individuals to risk of CAD.

Components of the type A coronary-prone behavior pattern and cardiovascular responses to psychomotor performance challenge.

The present study tested the general hypothesis that behavioral attributes most predictive of the incidence of coronary heart disease (CHD) in epidemiological research would also be most predictive of sympathetic autonomic nervous system (ANS) arousal in response to performance challenges. Subjects (n=50) were challenged to respond rapidly and accurately on three tasks involving either perceptual-motor or cognitive skills, while the experimenter monitored blood pressure, heart rate, and galvanic skin potential. The hypothesis was generally confirmed in that (1) type A subjects showed significantly greater cardiovascular changes indicative of sympathetic ANS arousal than type B subjects, (2) the Rosenman and Friedman structured interview was a better predictor of this arousal than the Jenkins Activity Survey, as is the case in CHD, and (3) the stylistic and behavioral components of the type A pattern (as defined by the structured interview) which are most predictive of CHD were also found to be the best predictors of challenge-induced sympathetic ANS arousal. The implications of these results for refinements in the definition, assessment, and modification of coronary-prone behavior are discussed.

Components of type A, hostility, and anger-in: further relationships to angiographic findings.

In a previous study of patients undergoing angiography at Duke University Medical Center, we reported that of all components of the Type A behavior pattern (TABP), only Potential for Hostility and Anger-In were significantly associated with extent of coronary artery disease (CAD). The present study was undertaken to replicate these findings using a different patient population. Tape-recorded structured interviews from 125 angiography patients at Massachusetts General Hospital were blind scored using the component scoring system employed in the Duke study. The results confirmed our previous findings. Global TABP was completely unrelated to extent of CAD, while Potential for Hostility and Anger-In were significant independent predictors of disease severity. These findings argue for a reconceptualization of the manner in which the TABP is defined and assessed.

Physiologic reactions to social challenge in persons evidencing the type A coronary-prone behavior pattern.

Physiologic measures were recorded in Type A1 (n = 10) and Type B (n = 14) subjects while they engaged in a reaction-time task after receiving instructions emphasizing the need for rapid and accurate performance. Although resting levels were not significantly different, Type As responded with significantly greater increases than Bs in both heart rate and systolic blood pressure, suggesting greater sympathetic arousal. A significant baseline difference between the Types in heart rate variability was also observed suggesting greater lability in sympathetic-parasympathetic function in Type As. No differences between the Types were obtained for either galvanic skin potential (GSP) or speed of reaction. It is suggested that the paradigm used in the present study offers an inexpensive and efficient means by which cardiovascular reactivity in Type As and Bs may be explored in other and larger groups of subjects.

Interpersonal Interaction And Cardiovascular Response In Type A Subjects and Coronary Patients

The present study tested the hypothesis that Type A subjects respond with greater cardiovascular response than Type B subjects during the structured interview used to assess the Type A pattern. Coronary patients (n = 31) and patient controls (n = 33) were subjected to the interview and a history quiz while ECG and blood pressure were monitored. As predicted, Type A relative to Type B subjects evidenced significantly greater increases in both systolic and diastolic blood pressure, which were sustained over the course of the entire 12-15 minute interview. Type A subjects compared with Bs also showed significantly greater blood pressure elevations during the quiz. Coronary patients displayed significantly greater Type A attributes than control subjects and tended to show greater blood pressure elevations than controls during the interview. In addition, the quiz induced significant elevations in the blood pressure of coronary patients, but not patient controls, over that displayed during the interview, despite the presence of beta-adrenergic blocking medication. Implications of the findings for coronary-prone behavior and coronary heart disease are discussed.

The structured interview and questionnaire methods of assessing coronary-prone behavior in male and female college students

Several self-report measures of type A behavior were compared with the Rosenman and Friedman structured interview method of assessment in male and female college students. The student version of the Jenkins Activity Survey was found to correlate relatively weakly with the interview for both males and females, while scales derived from the Gough and Thurstone inventories showed moderate correlations with interview typing for both sexes. A brief scale derived from a recent reanalysis of the Framingham study correlated with the interview appreciably greater for females than for males. In all, these data suggest the need for caution in using only paper-and-pencil tests to assess type A behavior.

Desirability of control versus locus of control: Relationship to paralinguistics in the Type A interview.

David Glass has suggested that need for control is an important dimension underlying the Type A coronary-prone behavior pattern. However, this hypothesis has never been directly tested. Findings from the present study supported the hypothesis by showing a significant relationship between measures of desire for control and the Type A pattern as assessed by both the structured interview and questionnaire methods, and with Type A voice stylistics. In contrast, locus of control scores correlated only with the questionnaire-based measure of Type A, and were unrelated to desire for control scores, interview-defined Type A, and Type A noncontent speech characteristics. Some evidence suggests the hypothesis that autonomic nervous system arousal can create psychological discomfort that may serve to increase both need for control and Type A vocal stylistics. In addition, such vocal mannerisms may actually facilitate control of the social environment. Evidence implicating genetic factors in these processes is discussed.

Selective cardiovascular effects of stress and cigarette smoking in young women.

In an earlier study, we found that men who smoked a cigarette and then engaged in a mildly stressful activity (video game) evidenced pronounced increases in heart rate and blood pressure, which were approximately equal to the sum of the effects produced by either smoking alone or stress alone. In the present study, a 2 (smoke vs. sham smoke) X 2 (stress vs. no stress) factorial design was used to evaluate the impact of stress and smoking on the cardiovascular responses of young women. The results revealed that the combination of stress and cigarette smoking produced blood pressure and heart rate responses that were larger than the additive effects of smoking and stress taken separately.

Propranolol medication among coronary patients: relationship to type A behavior and cardiovascular response.

The present correlational study compared behavioral and psychophysiological characteristics of coronary patients who were either medicated or not medicated with the beta-adrenergic blocking drug propranolol. Eighty-eight patients were given a structured Type A interview (SI) and a history quiz while heart rate and blood pressure were monitored. Data were analyzed controlling for age, sex, extent of coronary artery disease, and history of angina. Results indicated that patients taking propranolol (n = 65) were significantly lower in intensity of Type A behavior than patients not taking propranolol (n = 23). No effects were obtained for patients medicated or not medicated with diuretics, nitrates, or other CNS active drugs. Propranolol patients also showed lesser heart rate and rate-pressure product responses to the interview, but did not differ in blood pressure responses. Components of Type A which were lower in propranolol patients included speech stylistics (loud/explosive, rapid/accelerated, potential for hostility). Content of responses to the SI and scores on the Jenkins Activity Survey did not differ between the groups. An explanation for these results is offered in terms of the effects of propranolol on peripheral sympathetic responses, and evidence for a physiological substrate for Type A behavior. A conceptualization of the Type A pattern in terms of cognitive and physiological components is advanced, and implications for clinical intervention are discussed.

Gender differences in cardiovascular reactivity

Pronounced cardiovascular reactivity to stress is a behavioral mechanism that may underlie the pathophysiology of coronary heart disease (CHD). Based on the greater incidence of CHD among males than among females, the purpose of the current investigation was to test the hypothesis that in young adults (ages 17–29), males (n=47) show more cardiovascular reactivity than females (n=61) to two stressors, a video game and cigarette smoking. Five of the six comparisons did not support the hypothesis: females were higher on heart rate and diastolic blood pressure reactivity to both Stressors; males were higher on systolic blood pressure reactivity to the video game only. The results suggest that females may be particularly physiologically reactive to cigarette smoking.