Joel E. Dimsdale

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.

Type A personality and extent of coronary atherosclerosis

The relation between type A personality and the extent of coronary artery disease was studied in 109 patients who underwent selective coronary angiography. Type A personality as measured with the Jenkins Activity Survey was not correlated with the extent of coronary artery disease as assessed from the number of vessels with 50 percent or greater narrowing of diameter.

Effects of chronic stress on beta-adrenergic receptors in the homeless

&NA; This study examined the role of chronic life stress (homelessness), coping style, and hypertension on beta‐adrenergic receptors in a sample of homeless men. Sixteen healthy normotensive subjects and nine untreated hypertensive subjects were studied. Life stress was measured with the Brown and Harris categorization; coping style was measured with the Ways of Coping Scale. Lymphocyte beta‐adrenergic receptors were characterized in terms of receptor density (Bmax). Individuals with high life stress had lower Bmax (p < .005). In multiple regression analyses, 50% of the variance in Bmax was accounted for by life stress and coping style (p = .01). Receptor measures may be useful for characterizing the physiological response to continuing life adversity.

Type A behavior and angiographic findings.

Abstract This study examines the association between Type A personality and the extent of coronary artery disease found at angiography. Our initial work failed to demonstrate an association between Type A as measured by the Jenkins Activity Survey (JAS) and vessel disease. In this study on a second cohort of 105 patients, we have used both the JAS and semi-structured interview as measures for Type A personality. All patients were assessed prior to angiography. Coronary arteries were judged significantly narrowed if angiography revealed >50% narrowing of the vessels diameter. Neither the JAS nor the semi-structured interview were significantly associated with the extent of vessel disease. The discrepancy between our findings and those of other investigators may be attributable to population differences.

Anger assessment and reactivity to stress

This study compared a questionnaire method to an interview method of anger assessment in predicting reactivity to a stressor and explored possible associations between anger expression and reactivity to a stressor. Blood pressure, heart rate and plasma catecholamines were measured in 40 normotensive subjects before and after a 5 min mental arithmetic task. The questionnaire and interview anger scores were related (p = 0.03). Anger expressed outward was associated with lower heart rate (p = 0.005) and norepinephrine (p = 0.01) reactivity to the stressor. The results suggest that self report questionnaires may be a reliable and inexpensive way to evaluate anger in the context of reactivity to stressors and that anger expression, particularly anger expressed outward, may be related to decreased heart rate and norepinephrine reactivity. The relationship between anger expression and reactivity to stressors may provide insight into the mechanisms linking anger, blood pressure and incidence of cardiovascular disease.

Predicting cardiac morbidity based on risk factors and coronary angiographic findings

A cohort of 189 men was followed up for 1 year after performance of coronary angiography and determination of risk factors to ascertain which risk factors or clinical and laboratory findings could aid in predicting the patients who would have a substantial cardiac morbid event. Data on clinical signs and symptoms, psychosocial assessments, angiographic findings and presence of standard risk factors for coronary artery disease were collected in each case. Twenty-five percent of the men experienced a substantial cardiac morbid event (hospitalization, myocardial infarction, resuscitation or death). With or without inclusion of the patients who underwent surgery, discriminant analysis equations were successful in predicting morbidity on the basis of risk factor data. For the whole sample such analysis was significant at p < 0.00005 and accurately predicting the fate of 78 percent of the subjects. With exclusion of the surgically treated patients, the discriminant analysis accurately predicted future morbidity 83 percent of the time (p < 0.0001). The following risk factors for increased morbidity were common to both analyses: severity of angina, history of myocardial infarction, family history of heart disease, fatigue and absence of type A behavior.

Beta-adrenergic receptors predict heart rate reactivity to a psychosocial stressor.

&NA; We examined the ability of baseline measures of receptors (lymphocyte beta‐adrenergic) and nonreceptors (plasma catecholamines, heart rate, and blood pressure) to predict cardiovascular responses to a mental arithmetic task. Twenty‐five male volunteers served as subjects. Nonreceptor measures predicted the heart rate response to stress poorly (p = 0.67). However, beta receptor density and sensitivity explained 48.4% of the variance in heart rate response (p = 0.007). When both receptor and nonreceptor measures were used together, they predicted 76.6% of the variance (p = 0.005), which was more than was explained by either receptor or nonreceptor baseline measurements alone (p = 0.001). Receptor measures may thus greatly improve the prediction of reactivity.

Response Bias Influences Mental Health Symptom Reporting in Patients With Obstructive Sleep Apnea

The Medical Outcomes Study (MOS) inventory is widely used to assess quality of life in chronically ill patients. Although response bias was addressed during its initial validation, we are unaware of subsequent studies examining how personality characteristics influence responses on this instrument. We examined the impact of response bias on MOS data reported by 44 obstructive sleep apnea (OSA) outpatients who completed the MOS and Marlowe—Crowne Social Desirability Scale (MC). Social desirability implies responding in a way that the participant believes will be viewed favorably; MC is often used to statistically control for this form of response bias on self-report measures. The MOS yielded 2 summary scales (Mental and Physical Health) and 8 dimensions (based on Short Form-36 [SF-36]). Data were analyzed using multiple regression analyses. Results show that there is a significant relation between MC and the Mental and Physical Health factors (R2 = .194, F = 5.069, p = .011) and the eight SF-36 dimensions (R2= .359, F =2.448, p = .032). Post hoc analyses did not reveal that any one independent variable was a superior predictor of the MC. Participants scoring high on the MC reported 31% greater health than participants scoring low on the MC. Findings suggest that response bias has a significant influence on MOS data from OSA patients, with the greatest impact on mental health indexes. Controlling for response bias on the MOS and other self-report measures is important in both research and clinical situations with OSA and potentially other chronically ill patients.

Patterns of adrenergic receptors and adrenergic agonists underlying cardiovascular responses to a psychological challenge.

&NA; Numerous physiological and biochemical factors contribute to the dynamic regulation of the cardiovascular system. This study used a cluster analytic statistical technique to discern patterns of adrenergic receptors and adrenergic agonists underlying cardiovascular responses to a laboratory challenge. Fifty hypertensive and normotensive black and white individuals had their beta‐ and alpha‐adrenergic receptor sensitivity determined through agonist infusions. Norepinephrine, epinephrine, blood pressure, and heart rate responses to a standardized mental arithmetic task were also obtained. The cluster analysis identified four subgroups of individuals having distinct patterns of receptor and neurohormonal regulation of end‐organ responses. In general, the data indicated that end‐organ cardiovascular responses are, in part determined by the sensitivity of adrenergic receptors and the accompanying catecholamine responses. The findings also suggest that for some individuals nonadrenergic factors play a more dominant role than adrenergic mechanisms in determining cardiovascular pressor responses.

The promise of receptor studies in psychophysiologic research.

&NA; Most research on reactivity to stressors limits its focus to the neurohormonal and cardiovascular components of reactivity. There is, however, another area of investigation with important implications to this field. Receptor binding techniques provide a direct measure of the functional link between neurohormonal signals and the responses they stimulate. Receptor measurement would enable psychophysiologic studies to begin to address the complete triad of signal emission/reception/end‐organ response that underlies all reactivity patterns. This paper reviews adrenergic receptor physiology, methods, and research pertinent to reactivity. Our intention is to encourage greater consideration of these important issues in reactivity research.