Personality, Type A behavior, and coronary heart disease: The role of emotional expression.

The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern—Structured Interview (SI) versus Jenkins Activity Survey (JAS)—and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Inability to predict cardiovascular disease from hostility scores or MMPI items related to Type A behavior": Correction to Leon et al.

Reports an error in "Inability to predict cardiovascular disease from hostility scores or MMPI items related to Type A behavior" by Gloria R. Leon, Stephen E. Finn, David Murray and John M. Bailey (Journal of Consulting and Clinical Psychology, 1988[Aug], Vol 56[4], 597-600). In the aforementioned article, the mean Ho scores are incorrect. For Group 1, M = 16.0 (SD = 7.3); Group 2, M = 15.3 (SD = 6.7); Group 3, M = 15.2 (SD = 7.2). Page 600, paragraph 2 is no longer relevant. All other analyses and all conclusions are correct as reported. (The following abstract of the original article appeared in record 1989-05707-001.) Medical and psychological data collected for 30 years on a group of 280 men (mean age in 1947=45 years) were evaluated to identify the personality characteristics and attitudes that might be predictive of the later development of coronary heart disease (CHD). Minnesota Multiphasic Personality Inventory (MMPI) Hostility scores did not predict CHD in this population. A 35-item scale derived from MMPI items judged to reflect the Type A construct and from other personality scales did not predict the later incidence of myocardial infarctions or other evidence of CHD. It is therefore possible that personality factors may not be strong predictors of CHD in particular samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biobehavioral aspects of cardiovascular disease: Progress and prospects.

Discusses the impact of psychosocial factors, personality traits, genetic-behavioral interactions, sodium sensitivity, obesity, insulin metabolism, and psychophysiology on hypertension status. It is proposed that an understanding of pathophysiologic processes is needed to provide a better basis for risk factor reduction and other aspects of treatment. The study of myocardial ischemia appears to provide an important link between the development of coronary artery disease and the occurrence of coronary heart disease. Further studies are needed to assess the clinical significance of stress-induced ischemia as well as whether mental stress is predictive of future heart disease. Associations have been made between behavioral risk factors and heart disease, but the exact nature remains to be clarified. Hostility is an important factor in the development of coronary heart disease, but its impact needs to be studied fully. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise and gall bladder function

Epidemiological research has demonstrated protective effects of varying strength from physical activity against the risk for several chronic diseases such as coronary heart disease, hypertension, non-insulin-dependent diabetes mellitus and osteoporosis. Epidemiological studies have been supported by experimental research showing that exercise training improves coronary heart disease risk factors and other health-related factors. In contrast, the association between physical activity, exercise and gall stone disease has not yet been firmly established. This paper presents the theoretical role of aerobic exercise: (i) in the primary prevention of gall stone disease; and (ii) as a potential prokinetic agent in high risk gall stone disease groups. Primary risk factors in the pathogenesis of gall stone formation include cholesterol supersaturation in the solutes that precipitate from bile, hypernucleation (measured as "crystal appearance time') and finally hypomotility of the gall bladder which allows bile stasis and crystal formation. While the results of epidemiological studies suggest that physical activity may be inversely associated with gall stone disease, the mechanisms by which exercise may influence gall stone disease pathogeneses are poorly understood. In this paper the association between physical activity and exercise to gall bladder function and gall stone disease will be examined. Recommendations for future research and the implications for the primary prevention of gall stone disease will also be discussed.     

Environmental stress and biobehavioral antecedents of coronary heart disease.

This article provides an overview of research on the biobehavioral antecedents of coronary heart disease. Attention is given first to evidence that stressful occupational settings characterized by high demands and low levels of control over the job are associated with increased coronary risk. Also discussed is a promising animal primate model of social stress and coronary atherosclerosis. Next, the current status of the Type A behavior pattern is reviewed, with recent evidence suggesting that Type A may not be a potent risk factor in all populations. However, specific Type A components such as hostility as well as mode of anger expression (anger-in) have been related to coronary disease in recent studies. Next discussed is research on physiologic responsiveness (reactivity) to emotional stress, which is being studied as a marker of processes involved in the development of cardiovascular disease. Stress, Type A components, and psychophysiologic reactivity are promising candidates for research on clinical intervention. However, further evidence is needed before stress and reactivity can be regarded as proven risk factors for coronary disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

EEG source localization: implementing the spatio-temporal decomposition approach

The results of longitudinal studies in geriatric medicine were reviewed by referring to relatively recent publications. "Longidufinal studies" comprised not only cohort studies but also prospective case-control studies in the broad sense. Poor self-rated health, weight loss hypoalbuminemia, inability to perform activities of daily living, low levels of physical activity, and cognitive dysfunction, all of which could be manifestations of chronic diseases, might shorten longevity. Cardiomegaly or left ventricular hypertrophy on ECG were again found to be important risk factors for cardiovascular disease in the aged, because of their relation to atherosclerosis. There is no evidence regarding the contribution of hyperlipidemia to the risk of cardiovascular disease in the aged, although insulin resistance can increase serum triglyceride levels and reduced level of high-density lipoprotein cholesterol even in the aged. Mortality due to stroke and heart disease have been decreasing in most developed countries, and several recent community-based studies have also shown decreases in the incidence of cerebral stroke. Large-scale case-control studies on the pharmacological treatment of hyperlipidemia have resulted in both primary and secondary prevention of coronary heart disease. However, information concerning the effects of treatment for hyperlipidemia on coronary heart disease in the aged is limited. Results of large-scale case-control studies indicate that pharmacological treatment of elderly hypertensive patients can reduce cardiovascular morbidity and mortality, and angiotensin-converting enzyme inhibitors have recently been shown ot be useful.     

Insulin resistance implications for type II diabetes mellitus and coronary heart disease

PURPOSE: To review information on the implications of insulin resistance for type II diabetes mellitus (non-insulin-dependent diabetes mellitus) and coronary heart disease, and to derive guidance from this information for the management of these conditions. DATA SOURCES: A MEDLINE search of English-language articles published between 1985 and July 1996, and review of the bibliographies of articles obtained through the MEDLINE search and textbooks. STUDY SELECTION: Primary research articles, reviews and perspectives on the epidemiology of diabetes and cardiovascular diseases and on intervention outcomes in these diseases. DATA EXTRACTION: Study design and quality were assessed, with particular attention to methods, study population size and other characteristics. Conclusions of review articles and perspectives were analyzed critically. DATA SYNTHESIS: Type II diabetes is associated with a two- to fourfold excess of coronary heart disease, compared to nondiabetic populations. In most studies, glycemia and duration of clinical diabetes were found to be only weak risk factors for coronary heart disease. Conventional coronary heart disease risk factors such as dyslipidemia and hypertension have been associated with coronary heart disease in type II diabetes subjects. Hyperinsulinemia and insulin resistance have been predictive of the development of type II diabetes and, in some studies, of coronary heart disease. CONCLUSION: Strategies to prevent the development of coronary heart disease in diabetic and possibly prediabetic subjects should emphasize a multifactorial approach, including: a) improved glycemic control; b) aggressive treatment of risk factors for coronary heart disease, including insulin resistance; c) primary prevention of NIDDM; and d) use of glucose lowering agents that improve insulin sensitivity and cardiovascular risk factors.     

Gout and atherosclerosis

Recently atherosclerotic diseases, such as coronary heart disease and cerebrovascular disease have been considered as an important complication of hyperuricemia and gout. However, it is still controversial whether or not hyperuricemia is an independent risk factor of atherosclerotic diseases. On the other hand, several risk factors for coronary heart disease, for example hyperlipidemia and hypertension, are frequently observed in the patients with gout. Atherosclerosis in relation to hyperuricemia was discussed in view of definite and probable risk factors.     

Individual differences in need for cognitive closure

This article introduces an individual-difference measure of the need for cognitive closure. As a dispositional construct, the need for cognitive closure is presently treated as a latent variable manifested through several different aspects, namely, desire for predictability, preference for order and structure, discomfort with ambiguity, decisiveness, and close-mindedness. This article presents psychometric work on the measure as well as several validation studies including (a) a "known-groups" discrimination between populations assumed to differ in their need for closure, (b) discriminant and convergent validation with respect to related personality measures, and (c) replication of effects obtained with situational inductions of the need for closure. The present findings suggest that the Need for Closure Scale is a reliable and valid instrument of considerable potential utility in future "motivated social cognition" research.     

Hematology in classical nuclear medicine

Reference is made to the close relationship between high prevalent arterial hypertension and coronary heart disease, including the vascular risk factor as well as the common genetic and psychosocial factors that influence the development and parallel evolution of vascular and heart diseases. The importance of assessing of the total burden of coronary heart disease risk and its general management is emphasized and some aspects of the treatment of angina pectoris in hypertensive patients are mentioned.     

Disinhibitory psychopathology: A new perspective and a model for research.

The syndrome produced by septal lesions in animals can serve as a functional research model of human disinhibitory psychopathology which appears to span several traditionally separate psychological categories—psychopathy, hysteria, hyperactivity, antisocial and impulsive personality, and alcoholism. It is proposed that these categories are separate manifestations of the same genetic diathesis and that the "septal syndrome" may constitute a valid model of behavioral aspects of this diathesis. A program of experimentation utilizing this animal model is outlined. (65 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sunlight, cholesterol and coronary heart disease

We investigated the relationship between geography and incidence of coronary heart disease, looking at deficiency of sunlight and thus of vitamin D as a factor that might influence susceptibility and thus disease incidence. Sunlight deficiency could increase blood cholesterol by allowing squalene metabolism to progress to cholesterol synthesis rather than to vitamin D synthesis as would occur with greater amounts of sunlight exposure, and the increased concentration of blood cholesterol during the winter months, confirmed in this study, may well be due to reduced sunlight exposure. We show evidence that outdoor activity (gardening) is associated with a lower concentration of blood cholesterol in the summer but not in the winter. We suggest that the geographical variation of coronary heart disease is not specific, but is seen in other diseases and sunlight influences susceptibility to a number of chronic diseases, of which coronary heart disease is one.     

Psychological Perspectives on the Development of Coronary Heart Disease.

Psychological science has new opportunities to have major input into the understanding of the development of coronary heart disease. This article provides an overview of advances in understanding the etiology of heart disease, recently applied technologies for measuring early stages of heart disease, and an accumulating base of evidence on the psychosocial predictors of clinical and subclinical coronary disease. It suggests that it is now time to develop conceptual models that integrate our understanding of separate psychosocial predictors. It offers and provides preliminary evidence for a model that integrates socioeconomic status, environmental stress, and person-level factors from a life span perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inability to predict cardiovascular disease from hostility scores or MMPI items related to Type A behavior.

[Correction Notice: An erratum for this article was reported in Vol 58(5) of Journal of Consulting and Clinical Psychology (see record 2008-10621-001). In the article, the mean Ho scores are incorrect and some reported information is no longer relevant. The entries have been corrected and are included in the erratum. All other analyses and all conclusions are correct as reported.] Medical and psychological data collected for 30 years on a group of 280 men (mean age in 1947&=&45 years) were evaluated to identify the personality characteristics and attitudes that might be predictive of the later development of coronary heart disease (CHD). Minnesota Multiphasic Personality Inventory (MMPI) Hostility scores did not predict CHD in this population. A 35-item scale derived from MMPI items judged to reflect the Type A construct and from other personality scales did not predict the later incidence of myocardial infarctions or other evidence of CHD. It is therefore possible that personality factors may not be strong predictors of CHD in particular samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Schizophrenia genetics at the millennium: cautious optimism

As the new millennium approaches, research into the genetic aspects of schizophrenia has already made an impressive start toward an integrated model which is discovering roles for genetic agents, environmental agents and experiences, and chance factors. The best model follows that proposed for understanding such complex diseases as coronary artery disease and diabetes. Genetic information has come from both genetic epidemiology and molecular genetics. Evidence for gene regions on 6p and 8p gives the strongest support for harboring schizophrenia susceptibility genes, based on international collaborative studies that "generally" replicate one another; evidence for regions on 3p, 5q, 9p, 20p, and 22q, while less compelling, will encourage focused work. Determining the steps between the regions and the phenotype will challenge the next generation of scientists.     

Experimental evaluations of role playing.

This article is restricted to those studies which have been reported in which role playing was evaluated experimentally. Studies concerned with role playing as an assessment procedure and as a method for producing personality change are included in this report. Though there is a scarcity of experimental studies, the author concludes, with reference to personality assessment, "there is some sound evidence for believing that reliable and valid role-playing tests can be developed." The evidence with reference to personality change is as yet inconclusive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of prebirth parent personality and marital functioning on family development: A framework and suggestions for further study.

A framework for studying the impact of prebirth parent personality and marital functioning on family development is outlined. In the context of the delineation of four influences on infant and family development—namely, personality, social interaction, role, and ecology—the presentation focuses on the general hypothesis that certain relatively stable characteristics of the parents' personality and their marriage make an important and persistent impact on the family's development. Evidence for such stability is cited. As a further step in the delineation of prebirth influences, global and specific assessments of such influences were distinguished. Because variations in infant characteristics influence marital and parent personality functioning, the advantage of assessing this functioning before the birth of the first child is also stressed. Finally, the nature of the impact of certain stable aspects of the parents' personality and marital characteristics on a particular parent–infant transaction, infant soothability-responsiveness to need, is documented from existing research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal stability and validity of two personality disorder inventories.

The 3-mo temporal stability of self-report personality disorder scores from the Personality Diagnostic Questionnaire—Revised (PDQ—R; S. Hyler and R. Rieder, 1987) and the MMPI-Personality Disorder scales (MMPI-PD; L. Morey, M. Waugh, and R. Blashfield, 1985) was examined in a sample of 51 psychiatric outpatients. In addition, the convergent and discriminant validity of the scales from the PDQ—R and MMPI-PD were also assessed. Results indicate that PDQ—R and MMPI-PD scores were relatively stable over time, but support was obtained for the validity of only several of the personality disorder scales. Issues concerning the overlap of personality disorders as well as the lack of a "gold standard" to be used for establishing the validity of personality disorder instruments are discussed. Future research aimed at combining multiple forms of Axis II assessment (e.g., self-report, interview, informant) is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cytokines and heart diseases. Attempt at an update

Acute septic cardiomyopathy is-to our present knowledge-the heart disease most strongly interrelated with cytokines. Myocardial depression by cytokines is characterized by their pleiotropic actions mediating not only impairment of one, but several inotropic cascades. Information concerning the relevance of cytokines in non-septic heart diseases is-at present-scarce: Concepts emerge in cases of myocarditis, heart failure and cardiomyopathies, acute coronary syndromes, systemic inflammatory response due to cardiopulmonary bypass, heart transplant rejection and Kawasaki disease. CONCLUSION: Cytokines are involved in heart diseases.     

Reducing risk for cardiovascular disease.

The focus of this review article is to examine the importance of psychological and social factors in the development and maintenance of cardiovascular diseases, primarily coronary heart and artery disease, and to provide an overview of the effectiveness of psychosocial risk reduction interventions. First we summarize the prevalence and economic burden of cardiovascular disease, as well as the role of psychosocial factors in disease development and progression. We then examine the primary modifiable risk factors and evaluate the role of psychotherapists in the treatment of heart disease. Finally, we assess the effectiveness of risk factor modification and rehabilitation interventions, describe the potential costs and benefits of these programs, and discuss the role of primary prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)