Coronary artery disease
A prospective study of dominance and coronary heart disease in the normative aging study☆

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Abstract

The purpose of this study was to examine the prospective relation between dominance, as assessed by a Minnesota Multiphasic Personality Inventory (MMPI-2)-derived dominance scale, and incidence of coronary heart disease (CHD), independent of participants’ anger level. The study was performed in the VA Normative Aging Study, an ongoing cohort of older (mean age 61 years) men. A total of 1,225 men who were free of CHD in 1986 completed the MMPI-2. A factor analysis of selected MMPI items provided the basis for the construction of a dominance scale and an anger scale. During an average of 8 years of follow-up, 158 cases of incident CHD occurred, including 29 cases of fatal CHD, 69 cases of nonfatal myocardial infarction (MI), and 60 cases of angina pectoris (AP). Compared with men reporting the lowest levels of dominance (lower tertile), the multivariate-adjusted relative risk among men reporting the highest levels of dominance (upper tertile) was 1.80 (95% confidence interval [CI] 1.21 to 3.24) for combined nonfatal MI and fatal CHD. Additional adjustment for anger scores did not significantly alter this relation. There was no significant relation between dominance and AP. Our data suggest that dominance is an independent risk factor for CHD in older men.

Section snippets

Methods

This study was carried out in the Normative Aging Study, which is a longitudinal study of aging established by the Veterans Administration in 1961.11 The study cohort consisted of 2,280 men from the Greater Boston area who were from 21 to 80 years old at the time of entry. Volunteers were screened at entry according to health criteria,11 and were free of known chronic medical conditions (including diabetes mellitus) at the start of follow-up.

Results

The mean dominance score among subjects with complete and valid data was 6.66 (SD, 2.76; range 0 to 12). The distribution of responses to the dominance scale in the entire cohort is shown in Figure 1.

Table Ipresents the distribution of CHD risk factors as a function of dominance level. Compared with subjects with low dominance scale scores, subjects with high dominance scale score were younger, heavier, and more likely to be current smokers. Age, weight, and smoking are, of course,

Discussion

To our knowledge, this study is the first to report a significant prospective relation between questionnaire assessed dominance and CHD in men. Moreover, this relation remained significant even after adjusting for traditional risk factors and anger.

There are 4 other studies,1, 2, 3, 4, 5 in addition to the present one, that have also reported a significant positive relation between social dominance and CHD. A major difference between these previous studies and the present one is that in the

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    ☆

    This study was supported by grants HL 54098 and AG 02287. The Normative Aging Study is supported by the Cooperative Studies Program/ERIC, Department of Veterans Affairs, and is a component of the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, Massachusetts. Dr. Kawachi was supported by a Career Development Award from the National Heart, Lung and Blood Institute, Bethesda, Maryland; and by the MacArthur Foundation Network on Socioeconomic Status and Health, Chicago, Illinois.

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