The relationship of psychosocial factors to coronary heart disease in the Framingham study. II. Prevalence of coronary heart disease.

In a cross-sectional study of 1822 persons aged 45 to 77 years of age, the association of 20 psychosocial scales with coronary heart disease (CHD) prevalence was assessed. Women (aged 45 to 64 years) with coronary disease scored significantly higher on the Framingham Type A behavior, emotional lability, aging worries, tension, and anger symptoms scales than women free of CHD. The prevalence of CHD was significantly higher among working women and housewives classified as Type A than as Type B behavior. Among men under 65 years, Framingham Type A behavior, aging worries, daily stress, and tension were associated with the prevalence of myocardial infarction (MI). For men and women over 65 years, marital dissatisfactions or disagreements were significantly related to the prevalence of CHD. In a multivariate analysis, the above associations were controlled for age, blood pressure, cholesterol, smoking, and other psychosocial scales. Among women under 65 years of age, Framingham Type A behavior and emotional lability remained significant discriminators of CHD prevalence. Aging worries significantly differentiated men under 65 with and without MI. Issues related to the interpretation of results from cross-sectional studies are discussed, and four hypotheses are suggested for future prospective work in this area.