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J R Soc Med. 1993 July; 86(7): 406–409.
PMCID: PMC1293012

The current status of the coronary prone behaviour pattern.


Despite over 30 years of increasingly vigorous research it is still not possible to claim with acceptable certainty that there is an identifiable pattern of coronary prone behaviour nor to say with any confidence that the idea is misguided. The scientific process that leads from initial tentative findings through generation of a hypothesis, to rigorous and cumulative tests of that hypothesis has not happened. Instead there has been a rather erratic series of positive and negative studies, and the generation and modification of essentially rather similar hypotheses. As a result we are still in the position of claiming that there may be a pattern of behaviour that predicts CHD and that it is probable that hostility is involved. It is not clear why the idea is so persistent but it may well lie in the combination of a widely held lay belief that heart disease relates to stress and personality, with tantalizing positive findings occurring every few years. While there has been little increase in understanding of the role of behavioural factors in CHD as a result of this 30 years of endeavour there have been clinical benefits. It has clearly been shown that what are regarded as coronary prone behaviours can readily be modified and that their modification appears to confer some health benefits and no detectable health hazards.

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Selected References

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  • FRIEDMAN M, ROSENMAN RH. Association of specific overt behavior pattern with blood and cardiovascular findings; blood cholesterol level, blood clotting time, incidence of arcus senilis, and clinical coronary artery disease. J Am Med Assoc. 1959 Mar 21;169(12):1286–1296. [PubMed]
  • Rosenman RH, Brand RJ, Jenkins D, Friedman M, Straus R, Wurm M. Coronary heart disease in Western Collaborative Group Study. Final follow-up experience of 8 1/2 years. JAMA. 1975 Aug 25;233(8):872–877. [PubMed]
  • Matthews KA. Coronary heart disease and type A behaviors: update on and alternative to the Booth-Kewley and Friedman (1987) quantitative review. Psychol Bull. 1988 Nov;104(3):373–380. [PubMed]
  • Booth-Kewley S, Friedman HS. Psychological predictors of heart disease: a quantitative review. Psychol Bull. 1987 May;101(3):343–362. [PubMed]
  • Haynes SG, Feinleib M, Kannel WB. The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease. Am J Epidemiol. 1980 Jan;111(1):37–58. [PubMed]
  • Johnston DW, Cook DG, Shaper AG. Type A behaviour and ischaemic heart disease in middle aged British men. Br Med J (Clin Res Ed) 1987 Jul 11;295(6590):86–89. [PMC free article] [PubMed]
  • Mann AH, Brennan PJ. Type A behaviour score and the incidence of cardiovascular disease: a failure to replicate the claimed associations. J Psychosom Res. 1987;31(6):685–692. [PubMed]
  • Bortner RW. A short rating scale as a potential measure of pattern A behavior. J Chronic Dis. 1969 Jul;22(2):87–91. [PubMed]
  • Shekelle RB, Hulley SB, Neaton JD, Billings JH, Borhani NO, Gerace TA, Jacobs DR, Lasser NL, Mittlemark MB, Stamler J. The MRFIT behavior pattern study. II. Type A behavior and incidence of coronary heart disease. Am J Epidemiol. 1985 Oct;122(4):559–570. [PubMed]
  • Ragland DR, Brand RJ. Coronary heart disease mortality in the Western Collaborative Group Study. Follow-up experience of 22 years. Am J Epidemiol. 1988 Mar;127(3):462–475. [PubMed]
  • Ragland DR, Brand RJ. Type A behavior and mortality from coronary heart disease. N Engl J Med. 1988 Jan 14;318(2):65–69. [PubMed]
  • Frank KA, Heller SS, Kornfeld DS, Sporn AA, Weiss MB. Type A behavior pattern and coronary angiographic findings. JAMA. 1978 Aug 25;240(8):761–763. [PubMed]
  • Dimsdale JE, Hackett TP, Hutter AM, Jr, Block PC, Catanzano D. Type A personality and extent of coronary atherosclerosis. Am J Cardiol. 1978 Oct;42(4):583–586. [PubMed]
  • Dimsdale JE, Hackett TP, Hutter AM, Jr, Block PC, Catanzano DM, White PJ. Type A behavior and angiographic findings. J Psychosom Res. 1979;23(4):273–276. [PubMed]
  • Williams RB, Jr, Barefoot JC, Haney TL, Harrell FE, Jr, Blumenthal JA, Pryor DB, Peterson B. Type A behavior and angiographically documented coronary atherosclerosis in a sample of 2,289 patients. Psychosom Med. 1988 Mar-Apr;50(2):139–152. [PubMed]
  • Dembroski TM, MacDougall JM, Williams RB, Haney TL, Blumenthal JA. Components of Type A, hostility, and anger-in: relationship to angiographic findings. Psychosom Med. 1985 May-Jun;47(3):219–233. [PubMed]
  • MacDougall JM, Dembroski TM, Dimsdale JE, Hackett TP. Components of type A, hostility, and anger-in: further relationships to angiographic findings. Health Psychol. 1985;4(2):137–152. [PubMed]
  • Siegman AW, Dembroski TM, Ringel N. Components of hostility and the severity of coronary artery disease. Psychosom Med. 1987 Mar-Apr;49(2):127–135. [PubMed]
  • Hecker MH, Chesney MA, Black GW, Frautschi N. Coronary-prone behaviors in the Western Collaborative Group Study. Psychosom Med. 1988 Mar-Apr;50(2):153–164. [PubMed]
  • Dembroski TM, MacDougall JM, Costa PT, Jr, Grandits GA. Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial. Psychosom Med. 1989 Sep-Oct;51(5):514–522. [PubMed]
  • Barefoot JC, Dahlstrom WG, Williams RB., Jr Hostility, CHD incidence, and total mortality: a 25-year follow-up study of 255 physicians. Psychosom Med. 1983 Mar;45(1):59–63. [PubMed]
  • Shekelle RB, Gale M, Ostfeld AM, Paul O. Hostility, risk of coronary heart disease, and mortality. Psychosom Med. 1983 May;45(2):109–114. [PubMed]
  • McCranie EW, Watkins LO, Brandsma JM, Sisson BD. Hostility, coronary heart disease (CHD) incidence, and total mortality: lack of association in a 25-year follow-up study of 478 physicians. J Behav Med. 1986 Apr;9(2):119–125. [PubMed]
  • Roskies E, Seraganian P, Oseasohn R, Hanley JA, Collu R, Martin N, Smilga C. The Montreal Type A Intervention Project: major findings. Health Psychol. 1986;5(1):45–69. [PubMed]
  • Friedman M, Thoresen CE, Gill JJ, Ulmer D, Powell LH, Price VA, Brown B, Thompson L, Rabin DD, Breall WS, et al. Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: summary results of the recurrent coronary prevention project. Am Heart J. 1986 Oct;112(4):653–665. [PubMed]
  • Friedman M, Powell LH, Thoresen CE, Ulmer D, Price V, Gill JJ, Thompson L, Rabin DD, Brown B, Breall WS, et al. Effect of discontinuance of type A behavioral counseling on type A behavior and cardiac recurrence rate of post myocardial infarction patients. Am Heart J. 1987 Sep;114(3):483–490. [PubMed]
  • Gill JJ, Price VA, Friedman M, Thoresen CE, Powell LH, Ulmer D, Brown B, Drews FR. Reduction in type A behavior in healthy middle-aged American military officers. Am Heart J. 1985 Sep;110(3):503–514. [PubMed]
  • Myrtek M, Greenlee MW. Psychophysiology of type A behavior pattern: a critical analysis. J Psychosom Res. 1984;28(6):455–466. [PubMed]
  • Harbin TJ. The relationship between the type A behavior pattern and physiological responsivity: a quantitative review. Psychophysiology. 1989 Jan;26(1):110–119. [PubMed]

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