Ψ      Hostility and Heart Disease    Ψ

Hostility is the most frequently identified factor. In the 1960s Type A Behaviour Pattern was generally accepted as a description of a personality disposition for heart disease. The notion of a personality type is awkward: for example, one study found that nearly all Pentagon staff were Type As! More importantly, time-urgency was found to have little predictive power, and most of the validity of the Type A Structured Interview came from its hostility items. The trait most frequently associated with CHD at the present time can be called cynical hostility. The Cynical Distrust Scale (Everson, 1997) illustrates the trait:

• I think most people would lie to get ahead
• Most people inwardly dislike putting themselves out to help other people
• Most people make friends because friends are likely to be useful to them
• It is safer to trust nobody
• No-one cares much what happens to you
• Most people are honest chiefly through fear of getting caught
• I commonly wonder what hidden reasons another person may have for doing something nice to me
• Most people will use somewhat unfair means to gain profit or an advantage rather than lose it

'Cynicism', as measured by the Cook-Medley scale of the MMPJ, was the operational definition of hostility used by Barefoot, Dahlstrom & Williams (1983). Two hundred and fifty-five medical students were followed up over 25 years, and it was found that the CHD deaths by age 50 were five times higher in the most cynical group. 'Anger suppression' was the form of hostility reported by Julius, Harburg, Cottington & Johnson (1986). Six hundred and ninety-six Michigan subjects were followed over 12 years, and subjects who had indicated that they were likely to suppress anger when unjustifiably confronted by spouse had twice the mortality of those who expressed anger. Several reanalyses of Type A studies have shown most of the predictive power of TABP derives from its hostility items. For example, Hecker, Chesney, Black & Frautschi (1988) re-examined 250 CHD cases and 500 controls from the Western Collaborative Group Study (WCGS). Of the 12 behavioural characteristics extracted from the Structured Interview (SI), only hostility remained as a component when all 12 were included in the model.

Some traits found to predict CHD cannot be easily reduced to hostility. 'Submissiveness' was found to be protective against first MI in women by Whiteman (1997)

The majority of research reports have relied on responses to questionnaire statements. Psychological therapists tend to describe the emotion of anger. Redford Williams is director of Duke University's Behavioral Medicine Research Centre. This is what he wrote on anger and heart disease in a web-site for the ENRICHD trial:

"Hostility flares like a beacon, a risk factor that needs to be tempered, Williams says. This is not to say you should never get angry and you should never act on your anger. What I'm saying is if people who have excessive anger learn to control it, maybe it'll have beneficial effects."

Anger is an emotion, which is often (e.g in the RCPP) described as a consequence of threats to self-esteem. Williams recommends asking yourself four quick questions to decide whether you should act on the anger or cool it.

"Remember 'I AM Worth it,' and go down the list," he explains. Any "Yes" answers to the list indicate action on the anger, while a "no" tells the patient to let it go.

• I, is it important to me?
• A, is the anger appropriate?
• M, can the situation be modified?
• W, is this worth getting worked up over?"

The issue of traits and CHD is complex. The concepts of suspicious or resentful hostility, and pharisaic virtue are related to cynicism. More independent traits such as submissiveness have also been reported. Further links will be added to this page. A good starting-point is the review by Barefoot.

References

Barefoot, J.C. (1992). Developments in the measurement of hostility. In H.S. Friedman (Ed). Hostility, coping, and health, pp. 13-31. Washington, DC: American Psychological Association.

Barefoot, J. C., Dahlstrom, G. & Williams, R. B. (1983). Hostility, C.HD incidence and total mortality: A 25-year follow-up of 255 physicians. Psychosomatic Medicine, 45, 59~3.

Friedman, M., Powell, L., Price, V. & Dixon, T. (1984). Alteration of type A behaviour and reduction in cardiac recurrence in post myocardial infarction patients. American Heart Journal 108, 237-248.

Hecker, M., Chesney, M., Black, G. & Frautsehi, N. (1988). Coronary-prone behaviours in the Western collaborative group study. Psychosomatic Medicine, 50, 153-164.

Julius, M., Harburg, E., Cottington, E. & Johnson, E. (1986). Anger-coping types: Blood pressure and all-cause mortality: A follow-up in Tecumseh, Michigan. American Journal of Epidemiology, 124, 220-233.

Williams, R. B., Barefoot, J. C., Haney, T. L., Harrell, F. E., Blumenthal, J. A., Pryor, D. B. d Peterson, B. (1988). Type A behaviour and angiographieally-documented coronary atherosclerosis 2289 patients. Psychosomatic Medicine, 50, 139-142.

Whiteman,M, Deary,I, Lee,A, & Fowkes, F.(1997). Submissiveness and protection from coronary heart disease in the general population: Edinburgh Artery Study. The Lancet, 350: 541-45.



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