title: Type A behavior and risk of all-cause mortality, CAD, and CAD-related mortality in a type 1 diabetic population: 22 years of follow-up in the Pittsburgh Epidemiology of Diabetes Complications Study.
abstract: OBJECTIVE
  To determine whether type A behavior predicts all-cause mortality and incident coronary artery disease (CAD) in a type 1 diabetic population.
  
  
  METHODS
  Follow-up data (22 years) from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset type 1 diabetes were analyzed for the 506 participants who completed the Bortner Rating Scale (measuring type A behavior) and Beck Depression Inventory (BDI) at baseline (1986-1988). CAD comprised myocardial infarction as determined by hospital records/Q waves on electrocardiogram (ECG), CAD death (determined by a mortality classification committee), angiographic stenosis, ischemic ECG, and angina.
  
  
  RESULTS
  There were 128 deaths (25.3%) during follow-up. Univariate analysis showed an inverse relationship between Bortner scores and all-cause mortality (P=0.01), which remained significant after allowing for age, sex, duration, HbA1c, education, smoking, BMI, and physical activity (P=0.03). However, the addition of BDI scores attenuated the relationship (P=0.11) with a significant interaction (P=0.03) such that any protective effect against mortality was limited among individuals with lower BDI scores (bottom three quintiles) (P=0.07), whereas no effect was seen in those with higher BDI scores (P=0.97). Bortner scores showed only a borderline association with incident CAD (P=0.09).
  
  
  CONCLUSIONS
  Those with higher type A behavior have lower all-cause mortality in our type 1 diabetic population, an effect that interacts with depressive symptomatology such that it is only operative in those with low BDI scores. Further research should focus on understanding this interaction.
authors.affiliation: Corresponding author: Trevor J. Orchard, orchardt@edc.pitt.edu.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Fickley
authors.forename: Cathy E
authors.initials: CE
authors.lastname: Lloyd
authors.forename: Tina
authors.initials: T
authors.lastname: Costacou
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Miller
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Orchard
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D014434:Type A Personality; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin