lecture 9 type a behaviour, hostility and chd. lecture 8 reading there is material on type a and...
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Lecture 9
Type A behaviour, hostility and CHD
Lecture 8 Reading
There is material on Type A and hostility in the standard texts and general papers. See also
Johnston DW 1993. The current status of the coronary prone behaviour pattern. J. Roy. Soc. Med. 86, 406-409. Dated (but short).
Matthews, K 1988. Coronary heart disease and Type A behaviors: update on and alternative to the Booth-Kewley and Friedman (1987) quantitative review. Psychol. Bull. 104, 373-80. Plus reply 381-384. Interesting discussion of Type A as risk factor. Worth reading
Miller et al 1991 Reasons for the trend toward null findings in research on Type A behaviour. Psychol. Bull, 110, 469-485. Serious stuff, follows up on Matthews.
Lecture 8 reading (cont.)
Miller TQ et al, 1996. A meta-analytic review of research on hostility and physical health. Psychol. Bull., 119, 322-348. A comprehensive review. Best read after Matthews. Don’t get bogged down in tables.
Western Collaborative Group Study Rosenman, Brand, Jenkins, Friedman & Straus 1975
3154 men aged 30-59yrs classified on Structured Interview as either Type A or Type B
Extensive measurement of other risk factors
Followed up initially for 8.5 years for evidence of CHD, i.e., prospective study
Were Type A’s more likely to experience CHD?
Type A Type B
Number 1589 1565
No. with CHD 178 79
Incidence 13.2 5.9
(annual per 1000)
Could other risk factors explain the Type A & CHD link?
Analysed using multivariate statistics but also by simpler stratified analysis. Effects still present. See incidence rates for MI (39-49)
Type A Type B
Non smokers 7.4 3.4
Smokers 15.4 11.4
Normotensives 7.6 1.4
Hypertensives 33.1 12.6
Low Cholesterol 5.8 2.1
High Cholesterol 20.3 11.5
When is a risk factor casual, after Everson (conference discussant)
Temporality Strength of relationship
Consistency Biological gradient
Biological Plausibility Coherence
Outcome Specificity Intervention evidence
Causality (cont)
Temporality: are there prospective studies demonstrating that x precedes development of disease?
Strength of relationship: How much of the variance in disease incidence explained by x?
Consistency: Are studies consistent in their findings?
Biological gradient: is severity and/or frequency of x associated with increasing risk of disease?
Biological plausibility: what pathogenic mechanisms link x to disease?
Causality 3
Coherence: Does evidence for the relation between x and disease come from different samples (population, patient, animal models)?
Outcome specificity: Is the risk associated with x exclusive to one disease?
Intervention Effects: Is the disease prevented if x is treated early enough?
What happened to the WCGS later?
Ragland & Brand 1988 studied survival of 257 men who had experienced CHD in original 8.5 yr follow up
Ragland & Brand 1998 looked at mortality over 22 years in original sample.
Ragland & Brand, 1988
Ragland & Brand, 1998
Causality (cont)
Temporality: are there prospective studies demonstrating that x precedes development of disease?
Strength of relationship: How much of the variance in disease incidence explained by x?
Consistency: Are studies consistent in their findings?
Biological gradient: is severity and/or frequency of x associated with increasing risk of disease?
Biological plausibility: what pathogenic mechanisms link x to disease?
Causality 3
Coherence: Does evidence for the relation between x and disease come from different samples (population, patient, animal models)?
Outcome specificity: Is the risk associated with x exclusive to one disease?
Intervention Effects: Is the disease prevented if x is treated early enough?
Is Type A behaviour Unitary?
Many attempts to find active, toxic component
Hecker et al, 1988 rated tapes of 257 men who got CHD and 257 “controls” who did not in WCGS on many attributes.
Hostility significant risk factor, largely independent of Type A in this study. Relative Risk (RR) Hostility 1.92, Type A 2.68, allowing for each other Hostility 1.71, Type A 2.49.
Hostility - anger or irritation involving others or hostility to interviewer.
NB many now regard hostility as toxic component of Type A.
Williams et al, 1988
Mechanisms linking Type A or Hostility and CHD
CV reactivity
Effects of clotting process
Other (see Kop)
Lecture 10
Depression, Vital Exhaustion and recurrent heart disease
Lecture 9 references
Standard texts, Kop paper, and Krantz & Lundgren paper.
Depression and CHD is very current topic and there are few good reviews.
Kubzansky & Kawachi 2000. Going to the heart of the matter: do negative emotions cause coronary heart disease? J Psychosomatic Res., 48, 323-327 Review that includes depression.
Carney, R M., Freedland, Miller, M (2002) Depression as a risk factor for cardiac mortality and morbidity:A review of potential mechanisms. J Psychosomatic Res., 53, 897-902. Thoughtful discussion. This is one of a number of articles on depression & health in this issue of the journal
Depression DSM-IV
Five of following for at least 2 weeks
Sad mood most of day, most days
Loss of interest & pleasure in usual activities
Sleeping difficulties
Change in activity level
Change in eating patterns
Fatigue
Negative view of self
Less efficient thinking
Recurrent thoughts of suicide or death
Frasure-Smith et al, 1999. Gender, depression and one-year prognosis after myocardial infarction. Psychosomatic Med. 61, 26-37. (On web through library, worth reading)
Nancy Frasure-Smith major figure in proposing that depression makes reinfarction more likely. In this paper she combines her earlier studies to get large enough sample to examine effects of gender.
Sample. Women 283, Men 613.
Frasure-Smith, 1999
Barefoot et al, 2000 Depressive symptoms and survival of patients with coronary artery disease. Psych. Med. 62, 790-795.
1250 patients with CAD seen between 1974 & 1980 followed up for up to 19.4 years.
Measure Negative Affect. 6 item covering
Sad, crying, suicidal thoughts, irritability, restlessness
Vital Exhaustion (Ad Appels), see Kop
Features
lack of energy
increased irritability
demoralization
Vital exhaustion is short term predictor of MI, Rotterdam Civil Servant study. 3877 healthy men followed up for 4.2 years.
year 1 year 2 year 3 year 4
Years of follow up
0
3
6
9
12
15
Rela
tive R
isk o
f exh
au
sted
men
Rotterdam Civil Servants Study
RR
RR=1
Mechanisms for Depression CHD link
Reactivity. Probably not
Anti-depressants
Other Risk factors
Heart disease severity
Adherence and other behavioural mechanisms
Autonomic tone
Blood clotting processes. PF4 and BTG increased in depressed CHD patients
Inflammatory processes. Evidence of increased inflammation related to chlamydia in exhausted patients with CAD (Appels 2000)