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Can personality predict risk of coronary heart disease?

 

Many potential psychosocial risk factors for coronary heart disease have been identified including stress, Type A behaviour pattern, hostility and physiological reactivity to stress. This meta-analysis investigates the associations between coronary heart disease and Type A personality and hostility. Type A behaviour pattern is characterised by an excessive competitive drive, impatience and anger/hostility. While initial research investigated the overall Type A behaviour pattern, more recent studies have focused on its components, particularly hostility.

Bottom line

This meta-analysis found an association between coronary heart disease and a component of Type A personality, hostility.

Reference

M Myrtek. Meta-analyses of prospective studies on coronary heart disease, type A personality, and hostility. International Journal of Cardiology 2001 79: 245-251.


Search

The literature was searched using MEDLINE from 1966 to 1998. To be included studies had to be prospective and when a study had been published several times, the one with the longest follow-up period was chosen.

Thirty-five studies were identified: 25 investigating Type A personality and ten investigating hostility.

Different questionnaires were used to assess Type A personality and hostility. Myocardial infarction and coronary deaths were the only outcomes in some papers, while angina was included in others. Participants were either healthy adults or coronary heart disease patients. No further details were supplied.

Results

Separate meta-analyses were conducted for healthy adults, coronary heart disease patients and for studies which either included or excluded angina as an outcome.

Type A personality and coronary heart disease

The only significant association was found in healthy adults in studies which included angina as an outcome (11,115 adults, population effect size R = 0.046). In the analysis which included all studies there was no association between Type A personality and coronary heart disease (sample of 74,326, population effect size R = 0.003).

Hostility and coronary heart disease

A significant association was found in healthy adults in studies which did not include angina as an outcome (8,281 adults, population effect size R = 0.035). Analysing all studies also resulted in a significant association between hostility and coronary heart disease (sample of 15,038, population effect size R = 0.022).

Comment

The association between Type A personality and coronary heart disease observed in healthy adults in studies which included angina as an outcome may be due to one large, early study (conducted in 1975). No association was found in studies which used a more stringent design (i.e. not including angina as an outcome).

Although a significant association was found between hostility and coronary heart disease, the effect size was extremely low (R = 0.022). To put this into perspective, a population effect size of R = 0.10 is considered small, R = 0.30 moderate and R = 0.50 high.

The relationships between psychosocial factors and coronary heart disease are complex and individual studies have not always been consistent in their findings. The reasons for the inconsistent results between Type A behaviour and coronary heart disease are not clear. It has been suggested that Type A behaviour is not a risk factor for certain high-risk groups (and in this analysis, the only significant association between Type A personality and coronary heart disease was found among healthy adults in studies which included angina as an outcome). It has also been suggested that only particular components of Type A behaviour (particularly hostility) are associated with coronary heart disease (which again was observed in this analysis). It is interesting, and reassuring, that this meta-analysis finds what has generally been observed in individual papers over the years.

Several mechanisms have been proposed linking Type A behaviour, or components of it (i.e. hostility), to increased risk of developing coronary heart disease. In contrast to Type A behaviour, Type B behaviour is characterised by low levels of competitiveness, time urgency and hostility. It has been suggested, for example, that compared with Type Bs, Type A individuals respond more quickly and strongly to stress both in their overt behaviour and in their physiological responses (e.g. increased blood pressure and heart rate), producing more wear and tear on the cardiovascular system.

In conclusion, although this meta-analysis found an association between coronary heart disease and hostility, the practical significance of this finding at a population level is questionable. On an individual basis, several techniques are used to reduce stress and anger/hostility, e.g. stress management, cognitive behavioural therapy and exercise.