Type A behavior and mortality from coronary heart disease

The relation of behavior (Type A or Type B) to the morbidity and mortality of coronary heart disease (CHD) is still debated. We studied the survival of 257 male patients with CHD from the initial, 8.5-year phase of the Western Collaborative Group Study to see whether behavior type--as assessed by a structured interview before the CHD event--was related to subsequent CHD mortality. Behavior type was not related to mortality in 26 patients who died within 24 hours of the coronary event. However, of the 231 patients who survived for 24 hours, the mortality rate associated with CHD among 160 Type A patients studied during an average 12.7 years was 19.1 per 1000 person-years. This was unexpectedly lower than the corresponding rate of 31.7 among 71 Type B patients who were followed for an average of 11.5 years (P = 0.04). In a proportional-hazards survival analysis, which controlled for variable follow-up time, the type of initial coronary event, and traditional risk variables, the relative CHD-associated mortality rate among Type A as compared with Type B patients was 0.58 (P = 0.03; 95 percent confidence interval, 0.35 to 0.96). The lower mortality among Type A subjects occurred in both younger and older subgroups but was more pronounced in patients whose initial diagnosis was symptomatic myocardial infarction rather than silent myocardial infarction or angina pectoris. This apparent advantage associated with Type A behavior is surprising and needs confirmation, but the results do indicate that patients with CHD and a Type A behavior pattern are not at increased risk for subsequent CHD mortality.     

Additional evidence for the relationship between Type A behavior and social support in men

This study examined social support as a mediator of susceptibility to coronary disease in Type A individuals. Sixty-four male subjects completed the Jenkins Activity Survey and the Sarason Social Support Questionnaire. The correlations between Type A scores, the speed and impatience and hard-driving competitiveness factors of the Jenkins survey, and Sarason's social support were found to be negative, which was contrary to earlier findings. The authors hypothesize that these differing results may be a function of age and environment. Finally, and pertinent to the mechanism by which social support may be associated with coronary heart disease, systolic blood pressure was negatively correlated to satisfaction with social support.     

Type A and social support

This investigation tested Matthews's hypothesis, which proposed that reduced social support may be one of the mediators of susceptibility to coronary disease in Type A individuals. In addition, sex differences were hypothesized to be an important aspect of the findings. Subjects were 72 women and 57 men undergraduate students who completed the Jenkins Activity Survey (JAS) and the Sarason Social Support Questionnaire. For women, both the Type A and Speed and Impatience subscales of the JAS were negatively related to satisfaction with social support. For men, however, Type A scores on JAS were positively correlated with satisfaction with social support. The implications of these findings, particularly with regard to the importance of separate analyses by sex, are discussed.     

Anger rumination,social support,and cardiac symptoms in patients undergoing angiography

Objectives . Socially isolated individuals report more cardiac symptoms, suffer increased cardiovascular morbidity and mortality, and experience higher levels of stress and anxiety than those with more effective support resources. However, the complex interactions of psychosocial factors implicated in the disease process remain to be fully elucidated. We sought to explore these relationships, with the addition of a novel psychosocial variable, anger rumination, which could be associated with increased cardiovascular risk. Design . We examined the association of psychological stress, social support, and anger rumination, with surgical anxiety, self‐reported cardiac symptoms, and angiographically documented coronary artery disease, using a correlational ex post facto design. Methods . One hundred and one patients scheduled for elective coronary angiography completed questionnaires during the week prior to angiography. Disease severity was objectively assessed using the Gensini scoring system. Results . Self‐reported cardiac symptom severity was significantly correlated with higher perceived stress, less social support, and higher anger rumination, but none of the psychosocial variables predicted Gensini score. Social support partially mediated the relationship between anger rumination and surgical anxiety. Perceived stress mediated the relationship between anger rumination and cardiac symptoms. Conclusions . For patients awaiting angiography, stress, and lack of social support are important predictors of self‐reported cardiac symptoms, irrespective of actual disease severity. Intervention could focus on reducing perceived stress by encouraging reappraisal and a support seeking, rather than a ruminative, anger coping style.     

Social support, type A behavior, and coronary artery disease

The interaction of Type A behavior and social support in relation to the degree of coronary artery disease (CAD) severity was investigated. One hundred thirteen patients undergoing diagnostic coronary angiography received the Type A structured interview (SI) and completed a battery of psychometric tests, including the Perceived Social Support Scale (PSSS). Statistical analyses revealed a Type by social support interaction, such that the probability of significant CAD was inversely related to the level of social support for Type As but not Type Bs. Type As with low levels of social support had more severe CAD than Type As with high levels of social support. On the other hand, this relationship was not present for Type Bs. These results are consistent with the hypothesis that social support moderates the long-term health consequences of the Type A behavior pattern.     

Type A behavior and marital interaction: Hostile-dominant responses during conflict

Previous research has indicated that the risk conferred by men's Type A versus B behavior depends, in part, on the personality characteristics of their spouses. In the present study of 60 married couples, we found that couples consisting of two Structured Interview-defined Type A's showed a larger increase in hostile/dominant behavior during discussions of marital conflicts than did couples consisting of two Type B's or a Type A husband and a Type B wife. Couples consisting of a Type B husband and a Type A wife displayed an intermediate level of hostile dominance. These results are consistent with previous speculations about interpersonal dynamics in Type A behavior and interaction patterns which might underlie spouse effects on Type A behavior and coronary risk.This research was supported by a University Research Committee grant awarded to T.W.S.     

Type A behavior and angiographically documented coronary atherosclerosis in a sample of 2,289 patients

To determine the relationship between Type A behavior pattern and angiographically documented coronary atherosclerosis (CAD), we analyzed risk factor, behavioral, and angiographic data collected on 2,289 patients undergoing diagnostic coronary angiography at Duke University Medical Center between 1974 and 1980. Multivariable analyses using ordinal logistic regression techniques showed that Type A behavior as assessed by the structured interview (SI) is significantly associated with CAD severity after age, sex, hyperlipidemia, smoking, hypertension, and their various significant interactions were controlled for. This relationship, however, is dependent upon age. Among patients aged 45 or younger, Type A's had more severe CAD than did Type B's; among patients aged 46-54, CAD severity was similar between Type A's and B's; and among patients 55 and older, there was a trend toward more severe CAD among Type B's than among Type A's. These Type A-CAD relationships did not appear to be the result of various factors relating to the selection of patients for angiography. Type A behavior as assessed by the Jenkins Activity Survey was unrelated to CAD severity. These findings suggest that SI-determined Type A behavior is associated with more severe CAD among younger patients referred for diagnostic coronary angiography. The reversal of the Type A-CAD relationship among older patients may be due to survival effects. Inadequate sample sizes, use of assessment tools other than the SI, and failure to consider the Type A by age interaction could account for failures to find a Type A-CAD relationship in other studies. We conclude that the present findings are consistent with the hypothesis that Type A behavior is involved in the pathogenesis of CAD, but only in younger age groups. The Type A effect in the present data is small relative to that of both smoking and hyperlipidemia, however, and future research should focus more specifically on the hostility and anger components of Type A behavior, particularly in younger samples.     

重复与单次自杀行为者的生活满意度、应对方式及社会支持

目的:比较重复与单次自杀行为者生活满意度主观感受方面的差异,了解重复与单次自杀行为者出院后不同时期应对方式和社会支持情况,丰富自杀干预理论素材。方法:用生活满意度主观评价条目询问115例住院自杀行为者对自杀5年前、1年前、1个月前、当前、自杀1个月后、1年后、5年后生活满意度,并在其出院18个月、3年、5年时,采用应对方式问卷(CSQ)和社会支持评定量表(SSQ)施测。将有自杀未遂史及出院后6年内再次出现自杀的列为重复自杀行为者,并与单次自杀行为者比较。结果:24例重复自杀行为者就诊住院时对不同时期生活满意度(当前满意度除外)主观评价及累加总分均低于91例单次自杀行为者[如总分(18.9±3.6)vs.(22.6±4.0);均P<0.05]。出院后3年、5年时评定,重复自杀行为者CSQ中的退避、自责、幻想得分高于单次自杀行为者,而CSQ中的解决问题、求助及SSQ的主观支持、支持利用度、支持总分低于单次自杀行为者(均P<0.05)。将应对方式、社会支持、主观满意度分别放入与精神疾病等变量进行logistic回归分析,结果患有精神疾病者(OR=3.39～7.68,均P<0.05)有较高的重复自杀风险,而同时将上述变量一起多因素logistic回归分析,所有变量与重复自杀的相关均无统计学意义(均P>0.05)。结论:相对单次自杀行为者,重复自杀者生活满意度主观评价低,应对方式不良,社会支持差,且具有持续性。精神疾病与生活满意度、应对方式、社会支持相互影响,这些因素中,精神疾病与重复自杀的联系可能更紧密些。     

The Type A belief system: relationships to hostility, social support, and life stress.

Certain core beliefs may underlie the Type A behavior pattern, predisposing individuals to health problems and impaired interpersonal relationships. Previous studies have revealed that the Type A Cognitive Questionnaire (TACQ), a self-report measure reflecting these beliefs, is indeed related to emotional distress. The current study assessed the TACQ's relationship to aspects of the interpersonal environment, including perceived social support and stressful events. It also investigated the TACQ's relationship to subtypes of hostility (ie, cynicism and paranoid alienation). Subjects were 111 college undergraduate volunteers. As hypothesized, the TACQ was significantly related to poor quality of social support and to greater perceived life stress. The TACQ appeared more strongly related to cynicism than to paranoid alienation. Findings were generally more pronounced for males. The discussion suggests that Type A beliefs may predispose individuals to health problems through impaired interactions with their interpersonal environment.     

Social interaction, cardiovascular activation and the Type A behavior pattern.

The purpose of the study was to explore the relationship between social interaction and cardiovascular activity during a conflict-inducing communication task in Type A and B subjects. One of the subjects, the leader, was instructed to lead the other subject, the follower, through defined routes on a city map merely by help of instructions. The subjects were facing each other on each side of a screen which allowed eye contact but shielded the maps from view. 40 male students (mean age 24 years) exhibiting Type A or Type B behavior according to the Videotaped Structured Interview participated in the study. The results demonstrated large cardiovascular increases during task performance, particularly for leaders, in systolic blood pressure and heart rate. There were no main effects of Type A vs. Type B, but dyads composed of two Type As showed larger increase in diastolic blood pressure during the conflict phase of the task compared to dyads composed of Type Bs.     

Developmental social isolation affects adult behavior,social interaction,and dopamine metabolite levels in zebrafish

The zebrafish is a social vertebrate and an excellent translational model for a variety of human disorders. Abnormal social behavior is a hallmark of several human brain disorders. Social behavioral problems can arise as a result of adverse early social environment. Little is known about the effects of early social isolation in adult zebrafish. We compared zebrafish that were isolated for either short (7 days) or long duration (180 days) to socially housed zebrafish, testing their behavior across ontogenesis (ages 10, 30, 60, 90, 120, 180 days), and shoal cohesion and whole‐brain monoamines and their metabolites in adulthood. Long social isolation increased locomotion and decreased shoal cohesion and anxiety in the open‐field in adult. Additionally, both short and long social isolation reduced dopamine metabolite levels in response to social stimuli. Thus, early social isolation has lasting effects in zebrafish, and may be employed to generate zebrafish models of human neuropsychiatric conditions.     

Clinical significance of sirtuin 1 level in sepsis: correlation with disease risk,severity, and mortality risk

This study aimed to investigate the value of sirtuin 1 (SIRT1) in differentiating sepsis patients from healthy controls (HCs), and its correlation with inflammation, disease severity, as well as prognosis in sepsis patients. Serum samples were collected from 180 sepsis patients and 180 age- and gender-matched HCs. The SIRT1 level in the serum samples was detected by enzyme-linked immunoassay. The clinical data of the sepsis patients were documented, and their disease severity scores and 28-day mortality rate were assessed. SIRT1 was decreased in sepsis patients compared with HCs, and the receiver operating characteristic curve (ROC) showed that SIRT1 distinguished sepsis patients from HCs (area under the curve (AUC): 0.901; 95% confidence interval (CI): 0.868-0.934). In sepsis patients, SIRT1 negatively correlated with serum creatinine (Scr), white blood cells (WBC), C-reactive protein (CRP), acute physiology, and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score, while it positively correlated with albumin. No correlation of SIRT1 with primary infection site or primary organism was observed. Furthermore, SIRT1 was reduced in 28-day non-survivors compared with 28-day survivors, and subsequent ROC showed that SIRT1 predicted 28-day mortality of sepsis patients (AUC: 0.725; 95% CI: 0.651-0.800), and its prognostic value was not inferior to Scr, albumin, WBC, and CRP, but was less than SOFA score and APACHE II score. In conclusion, measurement of serum SIRT1 might assist with the optimization of disease assessment, management strategies, and survival surveillance in sepsis patients.     

Cardiovascular reactivity, Type A behavior, and coronary heart disease: Comparisons between myocardial infarction patients and controls during laboratory-induced stress

Cardiovascular responses to a series of laboratory stressors were examined in middle-aged Type A and Type B men. The subjects were 30 patients with diagnosed myocardial infarction (NYHA Class 1) and 26 age-matched healthy controls. All subjects were nonsmokers in the normotensive range, and none were on medication. Blood pressure, heart rate, forearm blood flow and resistance, and impedance cardiography-determined response variables were obtained during performance and recovery periods of both mental and physical tasks. The patients showed elevated reactivity in systolic blood pressure and cardiac output and prolonged systolic lime ratio during mental stress tasks and elevated total peripheral resistance and lower cardiac output and stroke volume during physical tasks, as compared with control subjects. Thus, the difference in blood pressure reactivity between patients and controls appeared to be primarily dependent on the vascular component during physical tasks, whereas the mental tasks promoted a hemodynamic response pattern more consistent with beta adrenergic activation. Type A men, irrespective of coronary status, showed larger systolic and diastolic blood pressure response to both mental and physical stress than did Type B men.     

Frailty for predicting all-cause mortality in elderly acute coronary syndrome patients: A meta-analysis

BackgroundFrailty has been identified as a risk factor for mortality in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the association between frailty and all-cause mortality outcome in patients with ACS.MethodsPubmed and Embase databases were searched up to September 26, 2018 for the observational studies evaluating the association between frailty and all-cause mortality in elderly ACS patients. Outcome measures were in-hospital death, short-term all-cause mortality (≤6 months),and long-term all-cause mortality (≥12 months).The impact of frailty on all-cause mortality was summarized as hazard ratios (HR) with 95% confidence intervals (CI) for the frail versus nonfrail patients.ResultsA total of 9 cohort studies involving 2475 elderly ACS patients were included. Meta-analysis showed that ACS patients with frailty had an increased risk of in-hospital death (HR 5.49; 95% CI 2.19–13.77), short-term all-cause mortality (HR 3.56; 95% CI 1.96–6.48), and long-term all-cause mortality (HR 2.44; 95% CI 1.92–3.12) after adjustment for confounding factors. In addition, prefrailty was also associated with an increased all-cause mortality (HR 1.65; 95% CI 1.01–2.69).ConclusionsThis meta-analysis demonstrates that frailty independently predicts all-cause mortality in elderly ACS patients. Elderly ACS patients should be assessed the frailty status for improving risk stratification.     

大学生饮酒行为与社会支持及生活事件的相关分析

目的了解在校大学生饮酒行为及饮酒相关知识认知度的影响因素,并探讨大学生饮酒行为与社会支持、生活事件之间的相关性。方法应用青少年饮酒知识行为调查问卷、社会支持评定量表(SSRS)、生活事件量表(LES),采用方便随机抽样方法,对芜湖市2所高校9个专业559名大学生进行不记名调查,应用多因素logistic回归等方法分析大学生饮酒行为及其影响因素与社会支持、生活事件的相关性。结果①对大学生饮酒行为的多因素logistic回归分析显示,差异具有统计学意义的因素有性别(OR=4.51,P0.001)、月平均生活费(OR=1.67,P0.001)、体育锻炼情况(OR=1.71,P0.05)和饮酒相关知识认知度(OR=1.99,P0.001);②对大学生饮酒相关知识认知度的多因素logistic回归分析表明,差异具有统计学意义的因素为学校(OR=0.62,P0.01)、父母的婚姻状况(OR=1.53,P0.05)、老师谈论饮酒相关问题与否(OR=0.65,P0.05),以及饮酒与否(OR=0.62,P0.05);③对大学生饮酒行为与社会支持进行两独立样本t检验分析显示,两组的社会支持总分有差异(t=3.99,P0.001);④使用斯皮尔曼等级相关系数对大学生的饮酒行为与社会支持及生活事件之间进行了相关性分析,结果不饮酒组的正性生活事件与客观支持之间r=0.24(P0.05);饮酒组的正性生活事件与主观支持之间r=0.23(P0.01)、与社会支持之间r=0.23(P0.01),且生活事件与社会支持之间r=0.17(P0.05)。结论大学生饮酒行为与社会支持、生活事件之间存在着一定的相关性,可能性别、家庭环境、学校环境等因素影响着大学生饮酒行为。