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Type A Behavior Pattern is not a Predictor of Premature Mortality

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Abstract

Background

Type A personality was introduced in the 1950s and was defined as an action–emotion complex characterized by excessive competitive drive, intense striving for achievement, easily provoked hostility, aggressiveness, impatience, and exaggerated sense of time urgency. Despite many positive findings earlier, almost 50 years of studies have not yielded conclusive results regarding Type A as a risk factor for negative health outcomes and early death. This may partly be due to methodological weaknesses such as small and selected samples, short follow-up times, and varying ways to assess Type A across studies.

Purpose

We re-examined the association between the Type A concept with cardiovascular (CVD) and non-cardiovascular (non-CVD) mortality by using a long follow-up (on average 20.6 years) of a large population-based sample of elderly males (N = 2,682), by applying multiple Type A measures at baseline, and looking separately at early and later follow-up years.

Method

The study sample were the participants of the Kuopio Ischemic Heart Disease Risk Factor Study, (KIHD), which includes a randomly selected representative sample of Eastern Finnish men, aged 42–60 years at baseline in the 1980s. They were followed up until the end of 2011 through linkage with the National Death Registry. Four self-administered scales, Bortner Short Rating Scale, Framingham Type A Behavior Pattern Scale, Jenkins Activity Survey, and Finnish Type A Scale, were used for Type A assessment at the start of follow-up.

Results

Type A measures were inconsistently associated with cardiovascular mortality, and most associations were non-significant. Some scales suggested slightly decreased, rather than increased, risk of CVD death during the follow-up. Associations with non-cardiovascular deaths were even weaker.

Conclusion

Our findings further suggest that there is no evidence to support the Type A as a risk factor for CVD and non-CVD mortality.

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References

  1. Friedman M, Rosenman RH. Association of specific overt behaviour 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;169:1286–96.

    Article  CAS  PubMed  Google Scholar 

  2. Cooper T, Detre T, Weiss SM. Coronary-prone behavior and coronary heart disease: a critical review. The review panel on coronary-prone behavior and coronary heart disease. Circulation. 1981;63:1199–215.

    Article  Google Scholar 

  3. Myrtek M. Meta-analyses of prospective studies on coronary heart disease, type A personality, and hostility. Int J Cardiol. 2001;79(2–3):245–51.

    Article  CAS  PubMed  Google Scholar 

  4. Petticrew MP, Lee K, McKee M. Type A behavior pattern and coronary heart disease: Philip Morris’s “crown jewel”. Am J Public Health. 2012;102(11):2018–25.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Goštautas A, Perminas A. [Impact of the relationship between smoking and stressogenic behavior (type A behavior) and their cumulative effect on development of myocardial infarction and mortality (25-year follow-up data)]. Medicina (Kaunas). 2004;40(3):265–71.

  6. Toriola AT, Kurl S, Laukanen JA, Mazengo C, Kauhanen J. Alcohol consumption and risk of colorectal cancer: the FINDRINK study. Eur J Epidemiol. 2008;23(6):395–401.

    Article  CAS  PubMed  Google Scholar 

  7. Lynch JW, Kaplan GA, Cohen RD, Tuomilehto J, Salonen JT. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol. 1996;144(10):934–42.

    Article  CAS  PubMed  Google Scholar 

  8. Lakka TA, Salonen JT. Physical activity and serum lipids: a cross-sectional population study in eastern Finnish men. Am J Epidemiol. 1992;136(7):806–18.

    Article  CAS  PubMed  Google Scholar 

  9. Bortner RW. A short rating scale as a potential measure of pattern A behaviour. J Chron Dis. 1969;22:87–91.

    Article  CAS  PubMed  Google Scholar 

  10. Haynes SG, Levine S, Scotch N, Feinleib M, Kannel WB. The relationships of psychosocial factors to coronary heart disease in the Framingham study: I. Methods and risk factors. Am J Epidemiol. 1978;107:362–83.

    CAS  PubMed  Google Scholar 

  11. Jenkins CD, Zyzanski SJ, Rosenman RH. Jenkins activity survey manual. New York: Psychological Corporation; 1979.

    Google Scholar 

  12. Järvikoski A, Härkäpää K. A brief Type A scale and the occurrence of cardiovascular symptoms. Scand J Rehabil Med. 1987;19:115–20.

    PubMed  Google Scholar 

  13. Julkunen J, Idänpään-Heikkilä U, Saarinen T. Components of Type A behavior and the first-year prognosis of a myocardial infarction. J Psychosom Res. 1993;37:11–8.

    Article  CAS  PubMed  Google Scholar 

  14. Rosenman RH, Brand RJ, Jenkins CD, Friedman M, Straus R, Wurm M. Coronary heart disease in the Western collaborative group study: final follow-up experience of 8.5 years. J Am Med Assoc. 1975;233:872–7.

    Article  CAS  Google Scholar 

  15. Ragland DR, Brand RJ. Type A behaviour and mortality from coronary heart disease. N Engl J Med. 1988;318:65–9.

    Article  CAS  PubMed  Google Scholar 

  16. Dishman RK, Graham RE, Holly RG, Tieman JG. Estimates of Type A behavior do not predict perceived exertion during graded exercise. Med Sci Sports Exerc. 1991;23(11):1276–82.

    Article  CAS  PubMed  Google Scholar 

  17. Gallacher JE, Sweetnam PM, Yarnell JW, Elwood PC, Stansfeld SA. Is type A behavior really a trigger for coronary heart disease events? Psychosom Med. 2003;65(3):339–46.

    Article  PubMed  Google Scholar 

  18. USDHHS. Measuring psychosocial variables in epidemiologic studies of cardiovascular disease. U.S. Department of Health and Human Services. 1985, NIH publication no. 85–2270, 151–226.

  19. Langeluddecke P, Tennant C. Psychological correlates of the type A behaviour pattern in coronary angiography patients. Br J Med Psychol. 1986;59(pt 2):141–8.

    Article  PubMed  Google Scholar 

  20. Bennett P, Carroll D. Type A behaviors and heart disease: epidemiological and experimental foundations. Behav Neurol. 1990;3:261–77.

    Article  CAS  PubMed  Google Scholar 

  21. Reed D, Cohen J. Type A behavior and coronary heart disease among Japanese men in Hawaii. Circulation. 1982;66:945.

    Article  Google Scholar 

  22. Appels A. Type A behavior and risk of CHD in Holland. Biobehavioural Factors in Coronary Heart Disease. Winterscheid, 1984; June 12–15.

  23. Kittel F. Type A, and social factors in relation to CHD incidence. Eur Heart J. 1985;6:6.

    Google Scholar 

  24. Ray J, Bozek R. Dissecting the A–B personality type. Br J Med Psychol. 1980;53(2):181–6.

    Article  CAS  PubMed  Google Scholar 

  25. Jouve A, Drivet-Perrin J, Bernet A, Blanc MM, Ebagosti A, Laurens M. [Social-professional workload and psychological profile in coronary heart disease]. Ann Cardiol Angeiol (Paris). 1980;29(4):223–30.

    CAS  Google Scholar 

  26. Koskenvuo M, Kaprio J, Langinvainio H, Romo M. Mortality in relation to coronary-prone behavior: a six year follow-up of the Bortner scale in middle-aged Finnish men. Act Nerv Suppl. 1983;25:107–9.

    Google Scholar 

  27. 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;295(6590):86–9.

    Article  CAS  Google Scholar 

  28. 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):685–92.

    Article  CAS  PubMed  Google Scholar 

  29. Haynes SG, Feinleib M, Kannel WB. The relationship of psychosocial factors to coronary heart disease in the Framingham Study III. 8-year incidence of coronary heart disease. Am J Epidemiol. 1980;111:37–58.

    CAS  PubMed  Google Scholar 

  30. Eaker ED, Abbott RD, Kannel WB. Frequency of uncomplicated angina pectoris in type A compared with type B persons (the Framingham study). Am J Cardiol. 1989;63:1042–5.

    Article  CAS  PubMed  Google Scholar 

  31. Carmelli D, Dame A, Swan G, Rosenman R. Long-term changes in Type A behavior: a 27-year follow-up of the Western Collaborative Group Study. J Behav Med. 1991;14(6):593–606.

    Article  CAS  PubMed  Google Scholar 

  32. Carroll D. Health psychology: stress, behavior and disease. London: The Falmer Press; 1995.

    Google Scholar 

  33. Manuck SB, Kaplan JR, Matthews KA. Behavioral antecedents of coronary heart disease and atherosclerosis. Arterioscler. 1986;6(1):2–14.

    Article  CAS  Google Scholar 

  34. Jenkins CD, Zyzanski SJ. Behavioral risk factors and coronary heart disease. Psychother Psychosom. 1980;34(2–3):149–77.

    Article  CAS  PubMed  Google Scholar 

  35. Koskenvuo et al. (1981). In Towards the life-span theory of coronary-prone personality. Julkunen J. Paper presented at the 24th International congress of psychology, Sydney, Australi, August 28 – September 2, 1988.

  36. Williams RB, Barefoot JC, Haney TL, et al. Type A behaviour and angiographically documented coronary atherosclerosis in a sample of 2,289 patients. Psychosom Med. 1988;50:139–52.

    Article  PubMed  Google Scholar 

  37. Miller TQ, Turner CW, Tindale RS, Posavac EJ, Dugoni BL. Reasons for the trend toward null findings in research on Type A behaviour. Psychol Bull. 1991;110:469–85.

    Article  CAS  PubMed  Google Scholar 

  38. Ray JJ. If ‘A–B’ does not predict heart disease, why bother with it? A comment on Ivancevich & Matteson. Br J Med Psychol. 1991;64(Pt 1):85–90.

    Article  PubMed  Google Scholar 

  39. Conduit EH. If A–B does not predict heart disease, why bother with it? A clinician’s view. Br J Med Psychol. 1992;65(Pt 3):289–96.

    Article  PubMed  Google Scholar 

  40. Gallacher J. Commentary: Type A behaviour and heart disease: no less inscrutable in Japan. Int J Epidemiol. 2008;37(6):1406–7.

    Article  PubMed  Google Scholar 

  41. Rosenman RH. Type A, behaviour pattern: a personal overview. In: Strube MJ, editor. Type A behaviour [a special issue], J Soc Behav Pers, vol. 5. 1990. p. 1–24.

    Google Scholar 

  42. Baker LJ, Dearborn M, Hastings JE, Hamberger K. Type A behavior in women: a review. Health Psychol. 1984;3(5):477–97. Review. PubMed PMID: 6399251

  43. Lawler KA, Huck SW, Smalley LB. Physiological correlates of the coronary-prone behavior pattern in women during examination stress. Physiol Behav. 1989;45(4):777–9. PubMed PMID: 2780847.

    Article  CAS  PubMed  Google Scholar 

  44. Anderson SF, Lawler KA. The anger recall interview and cardiovascular reactivity in women: an examination of context and experience. J Psychosom Res. 1995;39(3):335–43. PubMed PMID: 7636777.

    Article  CAS  PubMed  Google Scholar 

  45. Kuper H, Marmot M, Hemingway H. Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Semin Vasc Med. 2002;2(3):267–314.

    Article  PubMed  Google Scholar 

  46. Ioannidis JP. Discussion: why “An estimate of the science-wise false discovery rate and application to the top medical literature” is false. Biostatistics. 2014;15(1):28–36.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This analysis of KIHD study was financially supported by CIMO Fellowship.

Conflict of Interest

The authors declare that there are no conflicts of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Health Psychology, Lithuanian University of Health Sciences, Betonuotojų g. 4, 52371, Kaunas, Lithuania

    Kastytis Šmigelskas & Nida Žemaitienė

  2. Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland

    Juhani Julkunen

  3. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland

    Jussi Kauhanen

Authors
  1. Kastytis Šmigelskas
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  2. Nida Žemaitienė
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  3. Juhani Julkunen
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Correspondence to Kastytis Šmigelskas.

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Šmigelskas, K., Žemaitienė, N., Julkunen, J. et al. Type A Behavior Pattern is not a Predictor of Premature Mortality. Int.J. Behav. Med. 22, 161–169 (2015). https://doi.org/10.1007/s12529-014-9435-1

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  • DOI: https://doi.org/10.1007/s12529-014-9435-1

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