Biobehavioral basis of coronary-prone behavior in middle-age men. Part II: Serum cholesterol, the Type A behavior pattern, and hostility as interactive modulators of physiological reactivity

Prior research suggests that the Type A behavior pattern, Cook and Medley Hostility (Ho) scores, and Total Serum Cholesterol (TSC) are positively associated with physiological changes to behavioral stressors. The objective of the present study was to determine whether TSC interacts with the Type A behavior pattern and hostility to affect cardiovascular and neurohormonal responses to a mental arithmetic task (MATH). For Type A individuals, elevated TSC was associated with larger catecholamine and cortisol responses to MATH. In contrast, for Type B subjects, cholesterol was negatively associated with neurohormonal responses. The interaction between Ho score and TSC predicted a similar pattern of responses whereby, in high hostile men only, TSC was positively associated with MATH-induced changes in catecholamines and heart rate. While the mechanisms responsible for the differences in the lipid-reactivity association as a function of coronary-prone behavior measures remain to be elucidated, this differential association may play a role in the heightened risk of coronary disease among hostile Type A men.

Technique for continuous stride analysis of horses exercising on a treadmill

A technique for continuous computerised recording and analysis of the stride of horses on a treadmill is described. Advantages of the system are low cost, the use of normal shoes and the calculation of stride parameters in real time.

Hostility patterns and health implications: Correlates of Cook-Medley Hostility Scale scores in a national survey

Correlated Cook-Medley Hostility Scale (Ho) scores with sociodemographic variables in a national survey of 2,536 adults. Multiple regression models revealed that Ho scores were associated with race (p less than .0001), years of education (p less than .001), sex (p less than .001), occupation (p = .0002), and income (p = .0025). Higher scores were found in non-Whites, men, and those of lower socioeconomic status. There was a Race x Income interaction (p less than .005), such that the greatest Ho score differences between the races occurred among those with the lowest incomes. Age was related to Ho scores in a curvilinear fashion: higher scores in the youngest and oldest age groups than in the middle-aged groups (p = .025). Marital status was unrelated to Ho scores. These patterns of hostility are similar to the patterns of health indicators in the population. Because hostility has been found to be associated with adverse health outcomes, hostility may account for some of the demographic variations in health status. However, it is argued that research must first establish the generality of the hostility-health relationship across subgroups of the population.

Sternotomy infection: poor prediction by acute phase response and delayed hypersensitivity

Two hundred twenty-one consecutive adult cardiac surgical patients were examined prospectively for nutritional protein state, acute phase protein response, and delayed hypersensitivity reaction in an attempt to identify patients at high risk for the development of sternal wound infection, which occurred in 6 patients (2.7%). There was no significant correlation between preoperative nutritional protein concentrations (retinol-binding protein, prealbumin, and transferrin) and acute phase protein levels (C-reactive protein, alpha 1-acid glycoprotein, and complements B and C3), nor a statistically significant relationship between nutritional state or acute phase protein response and the development of sternal infection. Preoperative complement C3 levels were elevated, however, in 80.0% of those in whom sternal infections developed compared with 30.6% of those with well-healed wounds. Similarly, postoperative concentrations of alpha 1-acid glycoprotein were elevated in 80.0% of those in whom sternal infections developed compared with 28.6% of those with well-healed wounds. There was no correlation between delayed hypersensitivity and the risk of sternal infection, nor between preoperative nutritional protein and acute phase protein values. Seventy-three percent of patients were anergic on postoperative day 2. Stepwise logistic regression showed that age, body weight, preoperative intensive care unit stay, repeat median sternotomy, internal mammary artery grafting, postoperative hemorrhage, and postoperative cardiac arrest correlated with the development of sternal infection, whereas transfusion requirement, reexploration for bleeding, and the operation performed did not. We conclude that routine delayed hypersensitivity testing is of no value in predicting high-risk cardiac surgical patients when the anergy battery is placed on the preoperative day. Although statistically insignificant, possibly due to the small number of patients in whom sternal infection developed in this study (type II error), a larger study might find preoperative complement C3 and post-operative alpha 1-acid glycoprotein levels to be predictive of patients at risk for the development of sternal wound infection. The final logistic model for the predicted risk 2%) of sternal wound infection is: PREDSWC = exp(EQ)/1 + exp(EQ) where EQ = (0.38 x age) + (0.24 x weight) + (5.42 x preop ICU) + (4.39 x redo) + (7.14 x IMA) + (4.49 x hemorrhage) + (8.81 x arrest) - 62.72, and where preop ICU, redo, hemorrhage, and arrest are defined as yes (1) or no (0), IMA-is defined as 0, 1, or 2, age is in years, and weight is in kilograms.

Predicting personality in adulthood from college MMPI scores: implications for follow-up studies in psychosomatic medicine

To assess the long-term predictive utility of Minnesota Multiphasic Personality Inventory (MMPI) content scales, 1,960 individuals who had completed the MMPI in college in 1964 or 1965 were administered two measures of adult personality, the NEO Personality Inventory (NEO-PI) and the Cook and Medley MMPI Hostility scale, in 1988. A comparison group of 274 men and women in the Baltimore Longitudinal Study of Aging were given both MMPI and NEO-PI between 1981 and 1987. Predictive correlations between MMPI scales and NEO-PI factors were qualitatively similar to concurrent correlations, but approximately half as large in magnitude. Theoretically, these correlations were interpreted to mean that about half the variance in basic dimensions of personality is stable from college age into middle adulthood. Practically, the relatively modest correlations suggest that predictive studies of medical outcomes probably require large samples, and that baseline data from adults (e.g., over age 30) may be more useful for future studies. The combination of stability and change suggests that the decade of the 20s may be a particularly fruitful time to conduct research on interventions to alter personality and their effects on health outcomes.

The relationships between dimensions of hostility and cardiovascular reactivity as a function of task characteristics

The present study examined the independent relationships between dimensions of hostility and cardiovascular responses to a laboratory task with and without harassment. Fifty-three males, aged 18 to 26, with a negative parental history of cardiovascular disease were selected on the basis of their scores on the Cook and Medley Hostility (Ho) scale (greater than 24 or less than 14). Factor-analysis of six separate measures of hostility/anger resulted in a two-factor solution; Factor 1 representing antagonistic hostility and Factor 2 representing neurotic hostility. Results showed that high factor scores on antagonistic hostility were significantly associated with greater systolic blood pressure (SBP) and forearm blood flow (FBF) changes and poorer SBP recovery to harassment. In addition, high factor scores on neurotic hostility significantly predicted greater FBF changes to harassment. Additional correlational analysis showed that cardiovascular responses were positively associated with self-reported negative affects but only for subjects with high scores on either dimension. These results are in agreement with recent evidence suggesting that only antagonistic hostility may be related to increased severity of coronary artery disease and that the degree of interpersonal conflict moderates the association between coronary-prone behaviors and cardiovascular responses.

Effect of Type A behavior on exercise test outcome in coronary artery disease

The outcome of the diagnostic exercise test depends on such patient-related factors as age, maximum exercise heart rate, exercise time and severity of the underlying coronary artery disease (CAD). This study examined the hypothesis that type A behavior would affect the amount of effort expended, as indicated by the exercise time and the maximum heart rate achieved, thereby resulting in differences in exercise test outcome. A total of 1,260 patients with suspected CAD, all of whom had coronary angiography, a structured interview to assess type A behavior and a treadmill exercise test, participated. Of these patients, 818 (65%) had significant CAD, and 852 (68%) were type A. There were no differences between type A and B patients in either maximum heart rate or total exercise time. Among both type A and B subjects, 36% of treadmill tests were positive. Exercise test sensitivity was similar for both groups (69% for type A vs 72% for type B, p = 0.39). Similarly, specificity was similar for both groups (87% for type A vs 80% for type B, p = 0.09). Results did not change after using logistic regression to control for potential confounding factors. Thus, type A behavior does not need to be taken into account when interpreting exercise test outcome.

Caffeine effects on cardiovascular and neuroendocrine responses to acute psychosocial stress and their relationship to level of habitual caffeine consumption

The effects of a moderate dose of caffeine on cardiovascular and neuroendocrine stress reactivity were examined in 25 healthy male subjects selected as habitual or light consumers of caffeine. Measurements were taken under resting conditions before and after administration of caffeine (3.5 mg/kg) or placebo, during a stressful laboratory task, and in a post-stress recovery period. Caffeine elevated blood pressure and plasma norepinephrine levels at rest, effects which added significantly to the effects of stress. Caffeine potentiated stress-related increases in plasma epinephrine and cortisol stress, more than doubling the responses observed in the control condition. These effects were present in both habitual and light consumers and level of habitual caffeine consumption did not affect their magnitude. Results indicate that caffeine can potentiate both cardiovascular and neuroendocrine stress reactivity and that the habitual use of caffeine is not necessarily associated with the development of tolerance to these effects.

Clinical correlates and prognostic significance of type A behavior and silent myocardial ischemia on the treadmill

Type A patients with coronary artery disease (CAD) tend to ignore or underreport symptoms, especially during challenging tasks such as the treadmill exercise test. To determine whether type A CAD patients might be more likely than type B patients to have silent ischemia during exercise and consequently a worse prognosis, 403 patients with stable CAD who had significant coronary disease on angiography, a positive Bruce protocol treadmill test and a structured interview to assess type A behavior were studied. Median follow-up time was 6 years. Type A patients were more likely to experience silent ischemia during exercise than were type B patients (35 vs 25%, p = 0.05). Patients with silent ischemia during exercise had a history of fewer anginal episodes/week, and type A patients with silent ischemia were less likely to have had a history of typical angina. However, using the Cox model, there were no significant differences in survival between type A patients and B patients with silent ischemia (4-year survival 86 vs 79%, p = 0.44) and no significant differences in survival between type A patients with silent ischemia and type A patients with symptomatic ischemia (6-year survival 86 vs 80%, p = 0.59). Similar results were obtained for infarction-free survival. Type A patients are more likely than type B patients to have silent ischemia during exercise, but long-term survival is not affected.

Altered pituitary hormone response to naloxone in hypertension development

Endogenous opioid regulation of blood pressure is altered during stress in young adults at risk for hypertension. We studied the effects of the opioid antagonist naloxone on the secretion of corticotropin and beta-endorphin during psychological stress in young adults with mildly elevated casual arterial pressures. Naloxone-induced secretion of both corticotropin and beta-endorphin was significantly diminished in persons at enhanced risk for hypertension compared with the low blood pressure control group. Results suggest that opioidergic inhibition of anterior pituitary function is altered in hypertension development.

Type A behavior and survival: a follow-up study of 1,467 patients with coronary artery disease

Patients with documented coronary artery disease, admitted to Duke Medical Center between 1974 and 1980, were assessed for type A behavior pattern and were followed until 1984. The relation of type A behavior to survival was tested using data from coronary angiography to control for disease severity. Cox model regression analyses demonstrated an interaction (p less than 0.01) between type A behavior and an index of disease severity in the prediction of cardiovascular death. Among those with relatively poor left ventricular function, type A patients had better survival than type B. This difference was not present among patients with better prognoses. Type A behavior did not predict the subsequent incidence of nonfatal myocardial infarctions. Differential risk modification and differential selection into postinfarction status are possible explanations for the findings. These results need not conflict with the proposition that type A behavior plays a role in the pathogenesis of coronary artery disease.

Situational determinants of cardiovascular and emotional reactivity in high and low hostile men

Various epidemiologic studies have found that high scores on the Cook and Medley Hostility (Ho) scale are associated with increased risk of coronary heart disease (CHD), severity of atherosclerosis, and all-cause mortality. One plausible biological mechanism suspected of contributing to increased risk of CHD is sympathetic nervous system-mediated hyperresponsivity to environmental stressors. The present study evaluated cardiovascular reactivity among young men with high versus low Ho scores during performance of an anagram task with or without harassment. Compared to performing the task alone, harassment led to increased cardiovascular arousal that was more pronounced for the high Ho subjects than the low Ho subjects. Moreover, harassment produced increases in self-rated anger, irritation, and tension, but it was only among those subjects with high Ho scores that increased anger and irritation were associated with enhanced cardiovascular arousal. While suggesting a role for anger- and irritation-induced cardiovascular arousal in pathogenesis of CHD, these findings indicate that situation characteristics mediate the relationship between Ho scores and cardiovascular reactivity, and that there may be a differential biological link between anger/irritation and cardiovascular responses in men with high and low Ho scores.

Substitution of self-reporting for observing time spent on work activities by mental health professionals

Self-reported time spent on work activities by mental health professionals during 1147 1/2 hr. compared favorably with the results of a study that involved direct observation of professionals' time spent on work activities.

Beta and alpha adrenergic reactivity elicitable stress study with special reference of electrocardiographic T-wave amplitude

Twenty-six healthy young Caucasian males were defined into high hostile (Hi-Ho) group and low hostile (Lo-Ho) group assessed by Cook-Madley's Hostility (Ho) scale. Mental arithmetic task (MA) and forehead cold stimulus task (FCS) were loaded to both Hi-Ho and Lo-Ho groups. Electrocardiographic T-wave amplitude (TWA), heart rate (HR) and coefficient of variance of 100 R-R intervals (CVR-R) were measured continuously during MA and FCS task periods. Greater TWA attenuation was found in Hi-Ho group (p less than 0.05). Although no significant intergroup difference was represented in HR and CVR-R, HR increased significantly (p less than 0.01) in whole subjects and CVR-R was tend to be suppressed during MA period. In addition, comparison of these physiological responses were performed between Type-A and Type-B groups classified by Jenkins' Activity Survey Form-T (JAS-T). There was no significant difference in reactivity of TWA, HR and CVR-R to both two tasks between high and low Type-A scored groups. Previous data suggested that the TWA reactivity in Hi-Ho subjects to cognitive stress showed similar pattern in Type-A individuals. However, autonomic nervous interaction could not be clarified in Hi-Ho subjects. The differentiation of method for assessment of behavioral pattern was also discussed.

Patterns of cardiovascular responses to stress as a function of race and parental hypertension in men

This study investigated cardiovascular responses to two stressors known to elicit either beta-adrenergic (mental arithmetic) or alpha-adrenergic (forehead cold pressor) reactivity in Black and White men. Participants in each group were selected for presence or absence of parental hypertension. Based on previous research, Blacks were expected to show smaller cardiovascular responses to the beta-adrenergic mental arithmetic task and greater responses to the alpha-adrenergic cold pressor relative to the Whites. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, forearm blood flow, and forearm vascular resistance were assessed during a resting baseline, a prestress period, and during and after each experimental procedure. Unlike previous findings, no significant racial differences in cardiovascular responses were found during either task. However, Black participants had significantly higher SBP and DBP levels throughout the cold pressor periods. Parental history did not significantly influence cardiovascular responses in either group. The results are discussed in relation to previous research on racial differences in stress reactivity and their implications for future research.

Race, parental history of hypertension, and patterns of cardiovascular reactivity in women

This study examined the interaction of race and parental history of hypertension on patterns of cardiovascular responses among women. Two stressors were used that produce different patterns of cardiovascular reactivity: mental arithmetic, primarily a beta-adrenergic stimulus, and the cold face stimulus, which evokes alpha-adrenergic (i.e. vascular) activity. Systolic and diastolic blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were assessed before, during, and after arithmetic and cold face stimulus. Both tasks produced the expected patterns of cardiovascular adjustment, although no Black-White differences occurred during arithmetic. However, Black subjects did show a slower recovery of diastolic blood pressure following arithmetic. The cold face stimulus produced significantly greater changes in systolic blood pressure in the Black than in the White women. Parental history of hypertension did not relate significantly to reactivity. The results provide limited support for the idea that Black females exhibit a greater pressor response than White females to a stimulus that produces primarily vascular rather than cardiac changes. These findings are discussed in relation to previous findings with males and with respect to their implications for the role of reactivity in Black-White differences in hypertension prevalence.

The Cook-Medley hostility scale: item content and ability to predict survival

Previous studies have identified the MMPI-based Cook and Medley hostility scale (Ho) as a predictor of health outcomes. To achieve a better understanding of the construct measured by this scale, Ho items were classified on an a priori basis. Six subsets were identified: Cynicism, Hostile Attributions, Hostile Affect, Aggressive Responding, Social Avoidance, and Other. Study 1 examined the correlations of these subsets with scales of the NEO Personality Inventory in two samples of undergraduates. Good convergent and discriminant validity were demonstrated, but there was some evidence that items in the Social Avoidance and Other categories reflect constructs other than hostility. Study 2 examined the ability of the Ho scale and the item subsets to predict the 1985 survival of 118 lawyers who had completed the MMPI in 1956 and 1957. As in previous studies, those with high scores had poorer survival (chi 2 = 6.37, p = 0.012). Unlike previous studies, the relation between Ho scores and survival was linear. Cynicism, Hostile Affect, and Aggressive Responding subsets were related to survival, whereas the other subsets were not. The sum of the three predictive subsets, with a chi 2 of 9.45 (p = 0.002), was a better predictor than the full Ho scale, suggesting that it may be possible to refine the scale and achieve an even more effective measure of those aspects of hostility that are deleterious to health.