Coronary-Prone Behaviors, Hostility, and Cardiovascular Health: Implications for Behavioral and Pharmacological Interventions
Redford B. Williams Duke University Medical Center
Ever since the sudden deaths of Ananias and Saphira after being chastised by St. Peter -- as described in the "Acts of the Apostles" in the New Testament of the Christian Bible -- we have "known" that stress has the potential for profound effects on the heart. However, it was nearly 2,000 years later before two cardiologists, Meyer Friedman and Ray Rosenman, carried out epidemiological studies that pointed to a specific sort of stress -- that experienced by persons with the Type A behavior pattern that prospectively confers increased risk of developing coronary heart disease (CHD) ( 1).
Based on their work, and that of many other research groups, we were poised in the late 1970s to declare Type A an established CHD risk factor ( 1). However, at that same time, there began to appear several published reports of failures to find Type A predictive of or correlated with CHD outcomes. The most important of these negative studies was the failure by Shekelle et al. ( 2) to find Type A, as assessed by the structured interview, to predict CHD events in the large-scale Multiple Risk Factor Intervention Trial (MRFIT) study.
Based on these negative studies, as well as a consideration of preliminary data pointing to hostility as a correlate and predictor of CHD, numerous investigators turned their attention to the hostility component as the likely coronary-prone component of the global Type A construct. In this chapter, I first review the epidemiological evidence pointing to hostility as a coronary-prone psychological trait. I then review the evidence regarding the biobehavioral mechanisms, whereby hostility may be contributing to the development of CHD, as well as the potential neurobiological basis of the health-damaging biobehavioral char-