Karen A. Matthews
University of Pittsburgh
Department of Psychiatry

Judith M. Siegel
University of California at Los Angeles
Department of Public Health

In a medical psychology volume focusing on children, one may wonder why a
chapter related to coronary artery and heart disease is necessary. After all,
manifest coronary heart disease (e.g., heart attack, angina) is rare among the
young. Coronary heart disease (CHD) does not strike out of the blue, however. It
is typically the consequence of a life-long development of atherosclerosis in the
coronary arteries. This condition, called coronary artery disease (CAD) in its
advanced form, arises from the interplay of certain physiological and behavioral
factors which can begin prior to or during the second decade of life. Indeed, the
early beginning of CAD may be quite prevalent. Over half of the adolescent war
victims in two autopsy studies showed signs of coronary atherosclerosis ( Enos,
Holmes, & Beyer, 1953; McNamara, Molot, Stremple, & Cutting 1971).

As a consequence of these and other data, scientists are investigating in the
young the prevalence and development of the specific attributes known to charac-
terize adults prone to CAD and CHD. These specific attributes are called risk
factors. While the research on the physical risk factors, e.g., blood pressure,
serum cholesterol, and obesity, is extensive ( U.S. Department of HEW, 1978),
the research on the behavioral risk factors, e.g., smoking, extent of physical
activity, and the Type A behavior pattern, is minimal. This lack of research on
the Type A behavior pattern in the developing child is particularly surprising for
two reasons. First, it is a major CHD risk factor of equivalent strength to the most
powerful risk factors such as serum cholesterol level and hypertension ( Rosenman
, Brand, Jenkins, Friedman, Straus, & Wurm, 1975). Second, a precise,

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