Meta-analyses of prospective studies on coronary heart disease, type A personality, and hostility

Abstract

Background: Several large-scale prospective studies have failed to find an association between Type A personality (TAP) or hostility and coronary heart disease (CHD). The existing meta-analyses on this topic have several shortcomings, such as a selective search of the literature, the failed use of effect sizes, and methodological flaws. Methods: The present meta-analyses cover all prospective studies until the end of 1998. The correlation coefficient r is used as effect size to yield information on the population effect size R and variance. Several analyses have been carried out to stratify for disease endpoints, samples (healthy population, CHD patients), and methods used to determine TAP or hostility. Results: The population effect size (weighted average of all correlation coefficients) for TAP and CHD is R=0.003 ( n=74,326, P=0.213), and for hostility and CHD R=0.022 ( n=15,038, P=0.003). Conclusions: The population effect size for TAP and CHD is not significant. Hostility yields a significant association with CHD; however, the effect size is so low that it has as yet no practical meaning for prediction and prevention.