Is type A behavior really a trigger for coronary heart disease events?
OBJECTIVE
The purpose of this study was to compare chronic with acute mechanisms by which Type A might predict incident coronary heart disease (CHD).


METHODS
The study included 2394 men aged 50 to 64 years who were assessed for CHD, Type A behavior, and CHD risk factors. Type A was assessed using the Jenkins Activity Survey (JAS), the Bortner scale, and the Framingham scale. Further examinations were completed at 5 and 9 years for incident CHD.


RESULTS
After 9 years, there was no increased risk of CHD associated with any Type A score. Nevertheless, high Bortner scores were associated with increased risk of incident CHD at 5 years and high JAS and Bortner scores were associated with a decreased risk between 5 and 9 years. Further analysis of Type A scores on time to first coronary event found strong inverse associations for all type A scores (JAS = 205 -0.49 months to first event, 95% CI = -0.20, -0.78, p =.001) (Bortner = 176 -0.27 months; 95% CI = -0.10, -0.44; p =.002) (Framingham = 0.44 -0.0011 months; 95% CI = -0.0002, -0.0019; p =.01).


CONCLUSIONS
The data show Type A is a strong predictor of when incident coronary heart disease (or coronary event) will occur rather than if it will occur. These findings suggest that Type A increases exposure to potential triggers, rather than materially affecting the process of atherosclerosis.
Gallacher
John E J
JE
Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Heath Park, Cardiff, UK. Gallacher@cf.ac.uk
Sweetnam
Peter M
PM
Yarnell
John W G
JW
Elwood
Peter C
PC
Stansfeld
Stephen A
SA
D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010556:Personality Tests; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D013997:Time Factors; D014434:Type A Personality
D002784:Cholesterol