Hostility and Type A behaviour in coronary artery disease

Historical perspective and early research Systematic research on behavioural patterns related to increased risk of coronary artery disease (CAD) and its clinical manifestation as myocardial infarction was initiated by Friedman and Rosenman in the 1950s. The Type A Behaviour Pattern (TABP) was documented to be predictive of future myocardial infarction. TABP is defined as: ‘an action-emotion complex that can be observed in any person who is aggressively involved in a chronic, incessant struggle to achieve more and more in less and less time, and if required to do so, against the opposing efforts of other things or persons …’ (Friedman & Rosenman, 1959). Later research (reviewed below) has documented that hostility may be the ‘toxic’ component of TABP. Type A behaviour is characterized by an excessive competitive drive, impatience, hostility and vigorous speech characteristics. The complement of TABP was called Type B behaviour and was described as the relative absence of Type A characteristics. The early reports by Friedman, Rosenman and co-workers have resulted in numerous epidemiological and experimental investigations on the relationship between TABP and manifestations of coronary artery disease. In the 1960s and 1970s, most epidemiological studies supported the association between TABP and risk of future coronary artery disease (CAD) in men and women. The magnitude of these associations was comparable to that of traditional risk factors for CAD and also independent of these factors, such as hypertension and elevated lipid levels.