The relationship of type A behavior pattern to coronary heart disease.

We have attempted to review the majority, if not all, of the available literature concerned with the Type A behavior pattern. The data indicate that the concept of TABP has construct validity and that it does not reflect the distinguishing characteristics of personality traits or psychopathology that are measured by standard psychometric inventories. They support the belief that TABP is an interplay of certain personality attributes and the environmental milieu. This behavior pattern is found to have a causal association with the prevalence and incidence of coronary heart disease and the severity of coronary atherosclerosis in both sexes and predictive strength that is equivalent to the standard risk factors for CHD. The concept of TABP and its relevance for CHD are shown to have cross-cultural validity and to have specificity for CHD in a relationship that has a biological gradient of pathogenecity. TABP can be assessed with substantial replicability and probably can be quantified. The National Heart, Lung, and Blood Institute recently assembled a review panel of more than 50 eminent scientists representing a variety of biomedical and behavioral specialties in order to critically examine the evidence for the association between TABP and CHD. In the opening paragraph of the panel's final report, it was stated that "The Review Panel accepts the available body of scientific evidence as demonstrating that Type A behavior (as defined by the structured interview, JAS, and Framingham scale) is associated with an increased risk of clinically apparent CHD in employed, middle-aged U.S. citizens. This increased risk is over and above that imposed by age, systolic blood pressure, serum cholesterol, and smoking and appears to be of the same order of magnitude as the relative risk associated with any of these factors" (402).