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

Relationship of Psychological Characteristics to Daily Life Ischemia: An Analysis From the National Heart, Lung, and Blood Institute Psychophysiological Investigations in Myocardial Ischemia

OBJECTIVE

Cardiac ischemia during daily life is associated with an increased risk of adverse outcomes. Mental stress is known to provoke cardiac ischemia and is related to psychological variables. In this multicenter cohort study, we assessed whether psychological characteristics were associated with ischemia in daily life.

METHODS

This study examined patients with clinically stable coronary artery disease (CAD) with documented cardiac ischemia during treadmill exercise (n = 196, mean [standard deviation] age = 62.64 [8.31] years; 13% women). Daily life ischemia (DLI) was assessed by 48-hour ambulatory electrocardiophic monitoring. Psychological characteristics were assessed using validated instruments to identify characteristics associated with ischemia occurring in daily life stress.

RESULTS

High scores on anger and hostility were common in this sample of patients with CAD, and DLI was documented in 83 (42%) patients. However, the presence of DLI was associated with lower anger scores (odds ratio [OR] = 2.03; 95% confidence interval [CI] = 1.12-3.69), reduced anger expressiveness (OR = 2.04; 95% CI = 1.10-3.75), and increased ratio of anger control to total anger (OR = 2.33; 95% CI = 1.27-4.17). Increased risk of DLI was also associated with lower hostile attribution (OR = 2.22; 95% CI = 1.21-4.09), hostile affect (OR = 1.92; 95% CI = 1.03-3.58), and aggressive responding (OR = 2.26; 95% CI = 1.25-4.08). We observed weak inverse correlations between DLI episode frequency and anger expressiveness, total anger, and hostility scores. DLI was not associated with depression or anxiety measures. The combination of the constructs low anger expressiveness and low hostile attribution was independently associated with DLI (OR = = 2.59; 95% CI = 1.42-4.72).

CONCLUSIONS

In clinically stable patients with CAD, the tendency to suppress angry and hostile feelings, particularly openly aggressive behavior, was associated with DLI. These findings warrant a study in larger cohorts, and intervention studies are needed to ascertain whether management strategies that modify these psychological characteristics improve outcomes.

Ratings of perceived exertion by a group of women: does Type A behavior act a modifier?

It has previously been suggested that individuals displaying the Type A behavior pattern underestimate their perceived exertion during physical exercise. Most research pertaining to these results has been performed with male participants. In the present study, 70 women (mean age 26.8 yr.) varying in scores on the Bortner scale participated in a standardized cycle ergometer test performed individually in a laboratory setting. Analysis showed small but nonsignificant differences in ratings by participants. This held over the whole range from light to heavy exercise intensity. Less than 1% of the explained variance in ratings of perceived exertion (RPE) could be traced back to the scores for behavior of the individuals. Thus, contrary to some prior reports of RPE suppression associated with the Type A behavior pattern, the results present instead a null finding. Possible causes for the equivocal results are the environment (laboratory vs field), the question whether a laboratory test performed individually is perceived as challenging enough to trigger the competitive urge, type of exercise, the individual's sex, the measure used for assessing Type A behavior pattern, and whether gender-based schematic/aschematic processing is involved.