Type A Behavior and Survival after Acute Myocardial Infarction

• Published in: The New England journal of medicine Vol. 312; no. 12; pp. 737 - 741
• Main Authors: Case, Robert B, Case, Nan B, Heller, Stanley S, Moss, Arthur J
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Boston, MA Massachusetts Medical Society 21.03.1985
• Subjects: Analysis of Variance; Atherosclerosis; Behavior; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Coronary artery; Coronary heart disease; Coronary vessels; Family medical history; Health risk assessment; Heart; Heart attacks; Heart diseases; Hospitals; Humans; Male; Medical sciences; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - psychology; Personality Assessment; Population; Psychiatry; Risk; Surveys and Questionnaires; Survival; Type A Personality; United States; Ventricle; United States; Human; Type A behavior; Infarct; Acute; Myocardium; Cardiovascular disease; Psychopathology; Coronary heart disease; Survival
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198503213121201

To ascertain the influence of personality factors on the course of coronary artery disease, we measured Type A behavior in 516 patients within two weeks after an acute myocardial infarction, using the Jenkins Activity Survey questionnaire. Over a follow-up period of one to three years, there was no relation between the Type A score and total mortality, cardiac mortality, time to death for nonsurvivors, left ventricular ejection fraction, or duration of the stay in the coronary care unit. These negative findings were not changed by restricting the analyses to men below 61 years of age or by comparing extreme score categories. The contributions of behavioral, demographic, and cardiac physiologic factors to postinfarction mortality were also evaluated by multivariate survivorship analyses. The physiologic factors were the only ones that contributed a significant and independent mortality risk; the Type A score did not enter the survivorship model (relative risk, 0.8; 95 per cent confidence interval, 0.5 to 1.5). Thus, we found no relation between Type A behavior and the long-term outcome of acute myocardial infarction. (N Engl J Med 1985; 312:737–41.) THE influence of personality factors on coronary artery disease has become a subject of increasing interest and concern. Research in this area has focused mainly on the Type A behavior originally described by Friedman and Rosenman. 1 These investigators and their associates found that persons with a strong sense of the pressure of time, easily aroused hostility and aggression, and extreme dedication to achievement had an accelerated rate of development of coronary artery disease and its complications. 2 3 4 5 6 7 Type B behavior, with few of these characteristics, was thought to protect against coronary artery disease. There have been both confirmations 8 9 10 11 12 13 14 and denials 9 , 15 16 17 18 19 20 of . . .