Type A behavior: A frequently misdiagnosed and rarely treated medical disorder

Abstract

Ever since 1959 when I and Rosenman ~ first described the overt components of type A behavior and called attention to its possible relationship to the premature onset of clinical coronary heart disease (CHD), I have continued to a t tempt to discover as much as I could about the nature of this behavior. Thus, I and various colleagues 2-7 discovered in the 1960s and early 1970s that type A behavior could elevate the serum Cholesterol, triglyceride, norepinephrine, adrenocorticotropic hormone (ACTH), and testosterone levels, perhaps accounting for possible damage to blood vessels. Most of these biochemical and hormonal findings have been confirmed, s-9 As these laboratory studies were being done, Rosenman and I in 1960 and 1961 initiated the Western Collaborative Group Study ~° to determine whether type A behavior possessed predictive power for the incidence of clinical CHD. Results n showed that the behavior was a contributing factor. These findings subsequently were confirmed by the Framingham investigators 12 and other epidemiologic groups. In 1977 and 1978, several of us 13 at tempted to modify type A behavior in postinfarction subjects. Although this s tudy was planned to run for 5 years, a special committee from the National Heart, Lung, and Blood Institute, after perusing the data, concluded that the study should be discontinued because they believed it was obvious, even at the end of 3 years, that the data demonstrated that type A behavior could be modified and the cardiac recurrence rate dramatically lowered in the experimental group given type A counseling.' ~5 A subsequent s tudy 18 that involved for the first time healthy officers at the Army War College,