in terms of age, gender, relative risk, sociocultural factors, and sample size, it is hardly surprising that some investigations fail to find significant associations between a specific psychosocial variable and CHD. A quantitative summary of published research, however, has shown that Type A behavior is reliably related to CHD, and that the size of the relationship is comparable to traditional CHD risk factors. Furthermore, a meta-analysis of published studies has found that anxiety, depression, aggressiveness, and hostility are also reliably associated with CHR. The combined effect sizes for these variables are of similar magnitude as that observed between Type A and CHD.
Just as socioecological stressors and psychosocial variables appear to play a role in the pathogenesis of CHD, the psychosocial environment seems to play an important role in preventing CHD. Thus, socially integrated individuals with extensive social networks have a lower incidence of CHD, and, if stricken with MI, are less likely to die. Secondary prevention interventions that decrease Type A behaviors, such as time urgency and hostility, and increase social support and coping skills appear to decrease recurrence and mortality in post-MI patients.
Thus, it would appear that behavioral medicine approaches to the study of CHD and its prevention have much to commend them. Although there are many more questions than answers at this stage of the science, behavioral medicine offers a meaningful way to organize and synthesize the combined biomedical, behavioral, psychosocial, and sociocultural information that makes up the knowledge base concerning CHD and its prevention.
Because of the extensive range of information needed to understand the pathogenesis of CHD and its prevention, behavioral medicine approaches to prevention need to be broad and inclusive, not narrow and exclusive. Fortunately, an increasing number of disciplines are beginning to relate their activities to behavioral medicine approaches; scientists who once boasted of being disciplinary specific have become more comfortable with an interdisciplinary approach.
Within behavioral medicine, there is a need for scientists to understand, respect, and appreciate the fundamentals of the disciplines that contribute to the field. Thus, for example, individuals working within the area of CHD prevention need to know about traditional biomedical mechanisms of disease, as well as communication-persuasion models and behavior modification techniques. Fortunately, a cadre of such individuals has begun to appear in the area of CHD prevention.