Type A behavior, hostility, and coronary atherosclerosis

Personality traits and co-occurrence of depressive symptoms and high BMI: a prospective cohort study

We assess the associations between personality traits and co-occurrence of depressive symptoms and high BMI from adolescence to early adulthood. We employed a nationally representative cohort in China from 2010 to 2020 year. We included adolescents aged 10-19 years without depressive symptoms and unhealthy weight status (obesity, overweight, or thinness) at baseline and excluded those without any measurement of depressive symptoms or BMI at follow-ups. We assessed baseline personality traits in 7 dimensions of conscientiousness, openness, neuroticism, agreeableness, extraversion, self-esteem, and responsibility. We also assessed the combined effects of these 7 dimensions of personality traits by generating individual-level personality trait risk scores based on the weighted sum of all these 7 dimensions of personality traits. We measured the co-occurrence of depressive symptoms and high BMI using both a single measurement of depressive symptoms and BMI at the last follow-up and repeated measurements of them over 10 years. We used the multinomial logistic regression models to examine the exposure-outcome associations. At baseline, we included 1778 individuals (mean age: 14.4 year; female: 853 (48.0%)). At follow-ups, we observed increased risk of co-occurrence of depressive symptoms and high BMI per 1-SD increase in neuroticism score (1.95-2.38 odds ratio) or 1-SD decrease in self-esteem and conscientiousness (0.63-0.80 odds ratio; all P values < 0.05); we observed no evidence of associations between openness, agreeableness, extraversion, or responsibility and the risk of co-occurrence of depressive symptoms and high BMI (all P values > 0.05). For the combined effects of the 7 dimensions of personality traits, we found an elevated risk of co-occurrence of depressive symptoms and high BMI per 1-SD increase in the personality trait risk scores (OR (95% CI), single measurement at the last follow-up: 2.01, 1.66 to 2.43; trajectory classification using the repeated measurements 2.30, 1.55 to 3.42; average level using the repeated measurements: 2.27, 1.93 to 2.67). In this national cohort in China, personality traits were found to be associated with the co-occurrence of depressive symptoms and high BMI from adolescence to early adulthood. These findings highlight the importance of stratifying individuals based on their personality traits and providing targeted interventions for those at risk of comorbid depression and obesity.

Exploring the retrospective and prospective associations between the big five personality traits and clinical diagnosis of angina in middle-aged and older adults

OBJECTIVE

The goal of the present research was to test the retrospective and prospective associations between the Big Five personality traits and clinical diagnosis of angina while controlling for demographic characteristics.

METHODS

Data from middle-aged and older adults from a cohort study Understanding Society: the UK Household Longitudinal Study (UKHLS) were extracted and analyzed using binary logistic regressions (N = 10,124 for the retrospective study and N = 5485 for the prospective study). Personality was measured using a self-report 15-item version of the Big Five inventory between 2011 and 2012. Angina was measured by a self-report clinical diagnosis history question in each wave from until 2019. Covariates in our models included age, sex, income (monthly), education, and marital status.

RESULTS

Neuroticism was positively related to the likelihood of clinical angina diagnosis in both the retrospective (OR = 1.22, 95% C.I. [1.11, 1.34]) and the prospective (OR = 1.52, 95% C.I. [1.19, 1.94]) study whereas Extraversion had a positive association with odds of angina (OR = 1.52, 95% C.I. [1.17, 1.97]) in the prospective study only. The negative association between Openness and clinical angina diagnosis in the cross-sectional analysis is borderline significant (OR = 0.91, p = 0.048, 95% C.I. [0.83, 1.00]).

CONCLUSION

Our research indicated that personality traits are associated with the risk of angina. These findings emphasize the importance of considering personality traits in understanding the etiology of angina and potentially informing personalized prevention and intervention strategies.

Can the Big Five personality traits predict ever chance and 7-year risk of clinically diagnosed chronic bronchitis in middle-aged and older adults?

OBJECTIVE

Chronic bronchitis refers to a chronic condition that is characterized by long-term inflammation of the bronchi. It is of great importance to understand the contributing risk factors for chronic bronchitis because it is associated with adverse outcomes such as healthcare burden and mortality. We aimed to understand if the personality traits could predict ever and the 7-year risk of clinically diagnosed chronic bronchitis in a large cohort of participants from the UK.

METHODS

We analyzed data from Understanding Society: the UK Household Longitudinal Study, which consists of 15,387 middle-aged or older participants for the cross-sectional analysis and 8783 middle-aged or older adults for the longitudinal analysis using two binary logistic regressions.

RESULTS

We found that Neuroticism (OR = 1.36, p < 0.001, 95% C.I. [1.23, 1.51]), Conscientiousness (OR = 0.87, p = 0.014, 95% C.I. [0.78, 0.97]), and Extraversion (OR = 1.15, p = 0.009, 95% C.I. [1.04, 1.29]) are related to a higher chance of ever clinically diagnosed chronic bronchitis. However, Agreeableness and Openness were not related to the chance of ever clinically diagnosed chronic bronchitis. Moreover, Conscientiousness (OR = 0.72, p = 0.012, 95% C.I. [0.55, 0.93]) was related to a lower risk of future clinical diagnosis of chronic bronchitis whereas Extraversion (OR = 1.35, p = 0.024, 95% C.I. [1.04, 1.76]) was associated with a higher risk of future chronic bronchitis. However, Neuroticism, Agreeableness, and Openness were not related to change of ever clinically diagnosed chronic bronchitis.

CONCLUSION

We showed that personality can identify people who are at greater risk of chronic bronchitis, which has translational utility for healthcare of middle-aged and older adults.

Psychological factors and cardiac repolarization instability during anger in implantable cardioverter defibrillator patients

Background

Evidence indicates that emotions such as anger are associated with increased incidence of sudden cardiac death, but the biological mechanisms remain unclear. We tested the hypothesis that, in patients with sudden death vulnerability, anger would be associated with arrhythmic vulnerability, indexed by cardiac repolarization instability.

Methods

Patients with coronary artery disease (CAD) and an implantable cardioverter defibrillator (ICD; n = 41) and healthy controls (n = 26) gave an anger‐inducing speech (anger recall), rated their current (state) anger, and completed measures of trait (chronic) levels of Anger and Hostility. Repolarization instability was measured using QT Variability Index (QTVI) at resting baseline and during anger recall using continuous ECG.

Results

ICD patients had significantly higher QTVI at baseline and during anger recall compared with controls, indicating greater arrhythmic vulnerability overall. QTVI increased from baseline to anger recall to a similar extent in both groups. In ICD patients but not controls, during anger recall, self‐rated anger was related to QTVI (r = .44, p = .007). Trait (chronic) Anger Expression (r = .26, p = .04), Anger Control (r = −.26, p = .04), and Hostility (r = .25, p = .05) were each associated with the change in QTVI from baseline to anger recall (ΔQTVI). Moderation analyses evaluated whether psychological trait associations with ΔQTVI were specific to the ICD group. Results indicated that Hostility scores predicted ΔQTVI from baseline to anger recall in ICD patients (β = 0.07, p = .01), but not in controls.

Conclusions

Anger increases repolarization lability, but in patients with CAD and arrhythmic vulnerability, chronic and acute anger interact to trigger cardiac repolarization lability associated with susceptibility to malignant arrhythmias.

Stress and Illness: A Role for Specific Emotions

Research on stress and disease has often afforded an important role to emotion, typically conceptualized in broad categories (e.g., negative emotions), viewed as playing a causal role (e.g., anger contributing to pathophysiology of cardiovascular disease), and measured using self-report inventories. In this article, I argue for the value of evaluating specific emotions, considering bidirectional causal influences, and assessing actual emotional responding when considering the role that emotions play in the stress-disease relationship. In terms of specificity, specific emotions (e.g., anger, sadness, and embarrassment) can be linked with particular health outcomes (e.g., cardiovascular disease and musculoskeletal disease). In terms of bidirectionality, the influences of emotions on disease as well as the influences of disease on emotional functioning can be considered. In terms of assessing actual emotional responding, emotions can be studied in vivo under controlled conditions that allow behavioral, physiological, and subjective responses to be measured during different kinds of emotional functioning (e.g., responding to emotional stimuli, interacting with relationship partners, and downregulating emotional responses). With these considerations in mind, I review early theories and empirical studies in psychosomatic medicine that considered the role of specific emotions and emotion-related behaviors. Studies from our laboratory are presented that illustrate a) differences in patterns of autonomic nervous system responding associated with specific emotions, b) relationships between specific emotions and particular health outcomes in the context of social relationships, c) age as a moderator of the relationship between specific emotions and well-being, d) bidirectional influences (emotions influencing disease and disease influencing emotional functioning), and e) impact of changes in emotional functioning in individuals with neurodegenerative diseases on the health of familial caregivers.

Exercise Counteracts the Cardiotoxicity of Psychosocial Stress

Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.

Psychopharmacology and Cardiovascular Disease

This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.

Cardiovascular Profile of Valbenazine: Analysis of Pooled Data from Three Randomized, Double-Blind, Placebo-Controlled Trials

Introduction

Valbenazine is a novel vesicular monoamine transporter 2 inhibitor approved for the treatment of tardive dyskinesia in adults.

Objective

Using data from double-blind, placebo-controlled trials, analyses were conducted to evaluate the cardiovascular effects of once-daily valbenazine in patients with a psychiatric disorder who developed tardive dyskinesia after exposure to a dopamine-blocking medication.

Methods

Data were pooled from three 6-week, double-blind, placebo-controlled trials: KINECT (NCT01688037), KINECT 2 (NCT01733121), and KINECT 3 (NCT02274558). Data from the 42-week valbenazine extension period of KINECT 3 were also analyzed. Outcomes of interest included cardiovascular-related treatment-emergent adverse events, vital sign measurements, and electrocardiogram parameters.

Results

The pooled safety population included 400 participants (placebo, n = 178; valbenazine 40 mg/day, n = 110; valbenazine 80 mg/day, n = 112). A history of cardiac disorders was present in 11.8% of participants, and 74.3% were taking a concomitant medication with known potential for QT prolongation. Mean changes from baseline to week 6 in supine vital signs and QTcF (Fridericia correction) were as follows for placebo, valbenazine 40 mg/day, and valbenazine 80 mg/day, respectively: systolic blood pressure (0.2, − 2.1, − 1.8 mmHg), diastolic blood pressure (− 0.1, − 1.6, − 1.2 mmHg), heart rate (− 1.7, − 2.2, − 1.7 bpm), QTcF interval (1.2, 1.1, 2.1 ms); all p > 0.05 for valbenazine vs. placebo. No statistically significant differences were observed between placebo and valbenazine in cardiovascular-related, treatment-emergent adverse events. No notable additional effects on cardiovascular outcomes were found with up to 48 weeks of valbenazine treatment.

Conclusions

Results from double-blind, placebo-controlled trials showed no apparent difference between valbenazine and placebo on cardiovascular outcomes. No additional cardiovascular risk was detected during a longer extension study with valbenazine.

Comparison of the CBA-H and SF-36 for the screening of the psychological and behavioural variables in chronic dialysis patients

The aim of the study was to perform an analysis of the emotional reactions, perception of stressful life and behavioural changes related to Haemodialysis (HD) in order to identify those variables that can improve lifestyle and the adherence to treatment. Some psychometric assessment, such as the Cognitive Behavioural Assessment, Hospital Form, (CBA-H) and the Health Survey (SF-36), which provides two indexes: the Physical Component Score (PCS) and the Mental Component Score (MCS), are suitable to assess a patient’s psychological and behavioural style and their health-related quality of life. The study involved 37 Italian out-patients with end-stage renal disease under HD therapy. We calculated the Spearman correlation between variables of CBA-H, SF-36, age and time on HD. We also performed a multivariate linear regression using the CBA-H variables as predictors and PCS and MCS as dependent variables. From the CBA-H, 95% of participants self-reported psychological characteristics comparable to Type A personality, which identifies an anxious, hyperactive and hostile subject. Physical limitations were found to be directly proportional to the time on dialysis (r_s = -0.42). The condition of perceived stress worsens the state of mental health (r_s = -0.68) and general health perception (r_s = -0.44). The condition of vital exhaustion correlates both the PCS and the MCS (p<0.01) with possible outcomes of physical and mental illness. The psychological wellbeing of a dialyzed patient could be due to the combination of several factors, including life parameters, the positive perception of psychosocial outcomes, and the perceived quality of life. A multidisciplinary team (neurologists, psychiatrists, psychologists, and nurses) is essential to plan effective psychological and psychotherapeutic interventions to improve a mind-body integration.

Identifying Relationships between Self-Report Measures of Personality and the Type a Behavior Pattern

Relationships between self-report measures of personality and the Type A behavior pattern (TABP) were examined in a sample of eighty-eight male and female adults. TABP categorization was based on the Jenkins Activity Survey (JAS). Personality traits were measured by the Self-Monitoring Scale (SM), the Self-Deception Scale (SD), and the Impression Management Scale (IM). Predictions were that Type As would report lower scores than Type Bs on the SM and IM scales, but higher scores than Type Bs on the SD scale. Results indicated that independent of individual differences on other measures, age of subject, sex of subject, or social desirability responding that predictions were supported, with the exception that Type As reported lower scores than Type Bs on the SD scale. This suggests that self-report measures may be used to identify relationships between personality traits and TABP, and that Type As may be distinguished from Type Bs by trait tendencies toward low self-monitoring, low self-deception, and low impression management. This also suggests that distinctive Type A behavioral tendencies and coping strategies may be manifestations or consequences of specific trait tendencies.

Person-Environment Fit and its Limits: Agreeableness, Neuroticism, and Emotional Reactivity to Interpersonal Conflict

A naturalistic diary study was conducted to investigate the degree to which agreeableness and neuroticism moderate emotional reactions to conflict and nonconflict problems. Healthy community-residing males made diary recordings at the end of each of 8 successive days concerning problem occurrence and daily mood. Consistent with predictions based on person-environment fit, participants who scored higher in agreeableness experienced more subjective distress when they encountered more interpersonal conflicts than did their less agreeable counterparts. Neuroticism was related to a small but consistent reactivity to both conflict and nonconflict problems, contrary to person-environment fit. Reasons for the differences in the affective dynamics of agreeableness and neuroticism are discussed.

Hostility in Employed Women

Ninety-one women employed full-time outside the home were administered the Cook-Medley Hostility Scale. Information concerning various work -and nonwork-related variables was obtained by questionnaire and interview. Women with higher hostility scores reported having more stressful job experiences and feeling more daily stress and tension. Hostility scores were not found to be significantly related to stressful marital experiences or quality of general social support, although there were trends for hostility scores to be negatively related to social support from specific sources-namely, the women's supervisors and husbands. Finally, higher hostility scores were found to be related to greater outward expression of anger. The possibility is mentioned that having more stressful work and other daily experiences may contribute to mediating the relation between the Cook-Medley Hostility Scale and coronary artery disease in women.

Denial of Depression as an Independent Correlate of Coronary Artery Disease

A number of psychosocial measures were tested as correlates of coronary artery disease (CAD) in 122 males with positive coronary angiograms and 56 males with no manifest history of atherosclerotic disease who were selected to approximate the patients' age and socio economic status. Only denial of depression as indexed by spouse/friend-minus-self scores on the Ketterer Stress Symptom Frequency Checklist and number of unprovoked nocturnal awakenings were independently and positively related to CAD severity in multivariate regression analyses which controlled for jointly associated cardiac risk factors and commonly used cardiovascular medications. Denial of depression and unprovoked nocturnal awakening appear to be independent correlates of coronary artery disease.

Anger Expression, Coping Styles, and Well-being

This study examined the role of anger expression in the experience of stress, coping with stress and psychological and physical well-being. Based on a sample of 268 Singaporeans, the results, using structural equation modelling, indicated that anger expression was significantly related to reported stress, mechanisms for coping with stress and psychological wellbeing. Higher levels of anger expression were associated with higher levels of stress as well as lower use of active coping. Active coping was in turn positively related to psychological well-being. In addition, higher levels of anger expression showed a direct negative relationship with psychological well-being as did higher levels of stress. In contrast, the only significant predictor of physical well-being was reported stress, with higher levels of stress related to lower levels of physical well-being. The implications of these results for understanding the role of anger expression in psychological and physical wellbeing are discussed.

Components of the Anger–hostility Complex as Risk Factors for Coronary Artery Disease Severity: A Multi-measure Study

Different forms of anger and hostility have been implicated in the pathogenesis of coronary artery disease (CAD), though previous research has not measured all of these in one sample. To assess their relative predictive utility, a multi-measure study was undertaken of three adult outpatient groups: 97 men identified angiographically with stenosed coronary arteries; 28 men with valvular heart disorders in the absence of CAD; and 28 men attending a fracture clinic with no CAD present. Questionnaires measured: anger expression; anger experience; cynical hostility; ‘Ho' hostility; neurotic hostility; neurotic disagreeableness; resentment; and suspiciousness. The pre-eminent anger–hostility correlate of CAD was found to be expressed anger, with years as a smoker and age also being independently related to disease severity. Thus, seven of these anger/hostility variables do not warrant similar attention as anger expression in CAD aetiology. Further research should identify coronary toxic components of anger expression and of socio-occupational environments that afford or constrain their occurrence.

Counseling for Health

Good health and chronic diseases exist essentially as matters of habit as well as context in how people routinely go about the business of everyday living. Recently the crucial roles of behavioral, cognitive, and environmental factors in health and disease have been recognized, giving rise to the new fields of health psychology and behavioral medicine. The growing complexities involved yield a host of conceptual, methodological, and clinical problems. Examples include narrow definitions of health and disease, abuse of statistical significance testing in research, and confusing conceptualizations of chronic stress. To illustrate treatment possibilities, several ongoing broadly based intervention programs in the cardiovascular disease area are discussed. The many ways in which counseling psychologists might participate in problem areas in the health field clearly offer exciting challenges and opportunities.

Evaluation and Treatment of Agitation in the Intensive Care Unit

Agitation in the intensive care unit (ICU) patient is a complication of severe medical illness that requires prompt attention and treatment. The first step in managing an agitated ICU patient is a thorough investigation for factors that may cause or predispose to the agitated state. This entails detailed review of the history and available laboratory data as well as examination of the patient's physical and mental status. Important factors that may contribute to the development of agitation include (1) the presence of delirium or psychosis; (2) the type of ICU setting (e.g., coronary, surgical, respiratory, or medical); (3) a history of psychiatric disorder; (4) a history of central nervous system disorder; and (5) patients' personalities, which affect their reactions to illness and its treatment. The treatment of agitation is then based on its identified causes. The principles of treatment include (1) correction of metabolic and systemic abnormalities, (2) elimination of drug toxicity, (3) treatment of drug withdrawal, (4) maximization of the patient's comfort, and (5) use of neuroleptic medication. Medically oriented psychiatric consultants can help to organize the evaluation and management of the agitated patient and can assist staff members in dealing with their emotional reactions to difficult management problems.

Psychosocial Antecedents of Hostility in Persons with Coronary Heart Disease

Although it is known that hostility precedes coronary heart disease (CHD), little is known about factors that influence the development and progression of hostile characteristics. The relations among hostility, self-esteem, self-concept, and psychosocial residual were conceptualized within the modeling and role-modeling theoretical framework and examined in a sample of 85 persons with CHD. There were significant associations between all variables. Regression analyses revealed that self-esteem, mistrust residual, isolation residual, and self-concept contributed significantly, accounting for 31% of the variation in hostility scores. These findings provide support for the belief that the development of hostility in persons with CHD is related to beliefs and attitudes about the self and others. Persons with self-esteem need deficits, and a subsequent build up of negative psychosocial residual, have poor self-concepts. This poor self-concept is hostile in nature and reflects a mistrust of others and a deep sense of isolation.

Interpersonal emotional behaviors and physical health: A 20-year longitudinal study of long-term married couples

Objectively coded interpersonal emotional behaviors that emerged during a 15-min marital conflict interaction predicted the development of physical symptoms in a 20-year longitudinal study of long-term marriages. Dyadic latent growth curve modeling showed that anger behavior predicted increases in cardiovascular symptoms and stonewalling behavior predicted increases in musculoskeletal symptoms. Both associations were found for husbands (although cross-lagged path models also showed some support for wives) and were controlled for sociodemographic characteristics (age, education) and behaviors (i.e., exercise, smoking, alcohol consumption, caffeine consumption) known to influence health. Both associations did not exist at the start of the study, but only emerged over the ensuing 20 years. There was some support for the specificity of these relationships (i.e., stonewalling behavior did not predict cardiovascular symptoms; anger behavior did not predict musculoskeletal symptoms; neither symptom was predicted by fear nor sadness behavior), with the anger-cardiovascular relationship emerging as most robust. Using cross-lagged path models to probe directionality of these associations, emotional behaviors predicted physical health symptoms over time (with some reverse associations found as well). These findings illuminate longstanding theoretical and applied issues concerning the association between interpersonal emotional behaviors and physical health and suggest opportunities for preventive interventions focused on specific emotions to help address major public health problems. (PsycINFO Database Record

Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial

BACKGROUND

Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease. Despite considerable epidemiological evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR.

METHODS AND RESULTS

One hundred fifty-one outpatients with coronary heart disease who were 36 to 84 years of age were randomized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and coronary heart disease biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR made up the no-CR comparison group. All participants were followed up for up to 5.3 years (median, 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P=0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in coronary heart disease biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group (18% versus 33%; hazard ratio=0.49; 95% confidence interval, 0.25-0.95; P=0.035), and both CR groups had lower event rates compared with the no-CR group (47%; hazard ratio=0.44; 95% confidence interval, 0.27-0.71; P<0.001).

CONCLUSIONS

CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00981253.

Temperament and Character Profiles and Psychiatric Comorbidities in Patients With Coronary Artery or Valvular Heart Disease: Relationship With Cardiac Disease Severity

Background

We aimed to investigate whether the psychopathological symptoms and temperament-character dimensions observed in patients operated due to coronary artery disease (CAD) or valvular heart disease (VHD) differ among the patients and from healthy individuals.

Methods

Study population was composed of subjects with CAD, VHD and healthy controls (n = 50 in each group). Socio-demographic questionnaire, temperament and character inventory (TCI) and symptom check list-90-R (SCL-90-R) were applied to all groups. Groups were compared about temperament-character dimensions and scores of subscales of SCL-90-R.

Results

Harm avoidance was found to be higher in VHD group than those with CAD and, lower in healthy controls than both patient groups (P = 0.004). Reward dependence was similar among both patient groups and, was higher than healthy group (P = 0.015). Depression, anxiety, somatization, obsession and interpersonal sensitivity were found to be similar in both patient groups but they were higher than those in controls (P < 0.001, P < 0.001, P < 0.001, P = 0.002 and P = 0.003, respectively). Phobia was seen equally in CAD group and healthy controls and, was found to be lower in these than in VHD (P = 0.009). Anger score was in descending order in patients with VHD, CAD and healthy controls group (P = 0.010 and 0.001). Paranoia was in descending order in patients with VHD, CAD and controls (P = 0.015 and 0.001). A weak and inverse correlation was found between ejection fraction (EF) and the persistence dimension of temperament scaled by TCI in patients with VHD (r = -0.276, P = 0.052). An inverse correlation was observed between EF and the reward dependence dimension in CAD group (r = -0.195, P = 0.044). In patients with VHD, EF demonstrated an inversely weak (r = -0.289, P = 0.042), moderate (r = -0.360, P = 0.010) and strong (r = -0.649, P < 0.001) correlation with inter-personal sensitivity, phobia and paranoia, respectively. There was an inverse and weak correlation between EF and depression and anger in VHD group (r = -0.302, P = 0.033 and r = -0.240, P = 0.054).

Conclusion

VHD and CAD exhibit different psychopathological symptoms and temperament traits. There is a correlation between the aforementioned psychopathological symptoms and temperament traits, and EF.

Type A and Type B personality among Undergraduate Medical Students: Need for psychosocial rehabilitation

Objectives: To find out the frequency of Type A and Type B personality among the students of Undergraduate Medical College. To find association between student year and personality type.

Methods: A descriptive cross sectional study was conducted at Undergraduate Medical College, Rawalpindi from Sept. 2012 till Feb. 2013. Among 500 sample size, 100 students from each MBBS year were inducted by probability systematic sampling technique. After taking consent from the institute and students, data was collected on BECK anxiety inventory (BAI) questionnaire. According to BAI scale, students were identified as Type A or B personality. Data was analyzed using SPSS version 20. To find association between student year and personality type, Chi-square test of significance with 95% confidence level was used.

Results: First, second, third, fourth and final year students had 5 (1%), 6 (1.2%), 11 (2.2%), (13 (2.6%) and 19 (3.8%) type A personality respectively. Among all the study participants (n=500), total number of type A was 54 (10.8%) and type B personality students were 446 (89.2%). Type A personality was 29 (11.6%) in female students (n=250) and 25 (10%) in male students (n=250). Association between student year and personality type was significant (p=0.010) at 95% confidence level.

Conclusion: Type A personality students existed in every class and there was a gradual increase in the number of type A personality students from 1st year to final year in an undergraduate medical college of Rawalpindi. Significant association was observed in student year and type A personality.

Adaptation and implementation of an evidence-based behavioral medicine program in diverse global settings: The Williams LifeSkills experience

Epidemiological research has documented the health-damaging effects of psychosocial factors like hostility, depression, anxiety, job stress, social isolation and low socioeconomic status. Several studies suggest that behavioral interventions can reduce levels of these psychosocial factors. Herein we describe the translational process whereby the Williams LifeSkills® (WLS(®)) program and products for reducing psychosocial risk factors have been developed and tested in clinical trials in the U.S. and Canada and then adapted for other cultures and tested in clinical trials in other countries around the world. Evidence from published controlled and observational trials of WLS(®) products in the U.S. and elsewhere shows that persons receiving coping skills training using WLS(®) products have consistently reported reduced levels of psychosocial risk factors. In two controlled trials, one for caregivers of a relative with Alzheimer's Disease in the U.S. and one for coronary bypass surgery patients in Singapore, WLS(®) training also produced clinically significant blood pressure reductions. In conclusion, WLS(®) products have been shown in controlled and observational trials to produce reduced levels of both psychosocial and cardiovascular stress indices. Ongoing research has the potential to show that WLS(®) products can be an effective vehicle for the delivery of stress reduction and mental health services in developing countries.

A comparison of cook-medley hostility subscales and mortality in patients with coronary heart disease: data from the heart and soul study

OBJECTIVE

Hostility is associated with adverse outcomes in patients with coronary heart disease (CHD). However, assessment tools used to evaluate hostility in epidemiological studies vary widely.

METHODS

We administered nine subscales of the Cook-Medley Hostility Scale (CMHS) to 656 outpatients with stable CHD between 2005 and 2007. We used Cox proportional hazards models to determine the association between each hostility subscales and all-cause mortality. We also performed an item analysis using logistic regression to determine the association between each CMHS item and all-cause mortality.

RESULTS

There were 136 deaths during 1364 person-years of follow-up. Four of nine CMHS subscales were predictive of mortality in age-adjusted analyses, but only one subscale (the seven-item Williams subscale) was predictive of mortality in multivariable analyses. After adjustment for age, sex, education, smoking, history of heart failure, diabetes, and high-density lipoprotein, each standard deviation increase in the Williams subscale was associated with a 20% increased mortality rate (hazard ratio = 1.20, 95% confidence interval = 1.00-1.43, p = .046), and participants with hostility scores in the highest quartile were twice as likely to die as those in the lowest quartile (hazard ratio = 2.00, 95% confidence interval = 1.10-3.65, p = .023).

CONCLUSIONS

Among nine variations of the CMHS that we evaluated, a seven-item version of the Williams subscale was the most strongly associated with mortality. Standardizing the assessment of hostility in future epidemiological studies may improve our understanding of the relationship between hostility and mortality in patients with CHD.

The type A behavior pattern and cardiovascular disease as predictors of dementia

OBJECTIVE

Research has suggested that greater psychophysiological reactivity to stress increases risk of dementia and that those with the Type A behavior pattern (TABP) are predisposed to elevated stress reactivity and cardiovascular disease (CVD), but no study has evaluated the associations among TABP, CVD, and dementia, prospectively. Hence, the present study aimed to investigate dementia risk in relation to TABP and CVD.

METHODS

A population-based cohort of 1,069 persons with a baseline mean age of 64.81 years from the Swedish Twin Registry was followed consecutively for up to 23 years. Based on self-reported items, TABP was measured using 6 scales: Ambition, Stress, Hard-driving, Neuroticism, Cynicism, and Paranoia. CVD was self-reported and dementia was diagnosed adhering to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) or Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.

RESULTS

TABP was generally not associated with dementia risk. However, significant interaction effects of stress, paranoia, and cynicism with CVD on dementia risk were observed. That is, for those with CVD, high scores on stress, paranoia, and cynicism were associated with increased risk of dementia (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 0.95-2.15; HR = 1.39, 95% CI = 0.83-2.33; HR = 1.25, 95% CI = 0.76-2.06, respectively), whereas for those who did not have CVD, high scores on these measures appeared to be protective (HR = 0.76, 95% CI = 0.50-1.14; HR = 0.55, 95% CI = 0.34-0.89; HR = 0.50, 95% CI = 0.29-0.84, respectively).

CONCLUSION

Some features of TABP confer an increased risk for dementia in those with CVD, whereas those without CVD are protected. When evaluating the risk of dementia, CVD and personality traits should be taken into consideration.

Personality traits and chronic disease: implications for adult personality development

OBJECTIVE

Personality traits have been associated with chronic disease. Less is known about the longitudinal relation between personality and disease and whether chronic disease is associated with changes in personality. Method. Participants from the Baltimore Longitudinal Study of Aging (N = 2,008) completed the Revised NEO Personality Inventory and a standard medical interview at regularly scheduled visits; the Charlson Comorbidity Index, a weighted sum of 19 serious diseases, was derived from this interview. Using data from 6,685 visits, we tested whether personality increased risk of disease and whether disease was associated with personality change.

RESULTS

Measured concurrently, neuroticism and conscientiousness were associated with greater disease burden. The impulsiveness facet of neuroticism was the strongest predictor of developing disease across the follow-up period: For every standard deviation increase in impulsiveness, there was a 26% increased risk of developing disease and a 36% increased risk of getting more ill. Personality traits changed only modestly with disease: As participants developed chronic illnesses, they became more conservative (decreased openness). Discussion. This research indicates that personality traits confer risk for disease, in part, through health-risk behaviors. These traits, however, were relatively resistant to the effect of serious disease.

Relationship between hostility and subjective sleep quality

While hostility and sleep disturbance are the potential risk factors for health problems and disease, few studies have examined the relationship between the two factors. The present study was performed to investigate the relationship between hostility and sleep problems assessed both subjectively and objectively in a nonclinical sample. Sixty-one healthy subjects were enrolled in this study. Hostility was measured according to the Cook-Medley hostility scale. Subjective sleep quality was evaluated according to the global score of the Pittsburgh Sleep Quality Index. Objective sleep was evaluated using actigraphy. A multiple regression analysis revealed that a higher level of hostility was significantly associated with the global score of the Pittsburgh Sleep Quality Index and that a higher level of depression was not associated with the global score of the Pittsburgh Sleep Quality Index. Objective sleep measures were not found to be associated with hostility. Confirming the robust relationship between poor sleep and hostility would have several important treatment implications for preventing health problems.

Hostility, health behaviors, and risk of recurrent events in patients with stable coronary heart disease: findings from the Heart and Soul Study

BACKGROUND

Hostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease (CHD), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes.

METHODS AND RESULTS

We prospectively examined the association between self-reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8-item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow-up time of 7.4 ± 2.7 years, the age-adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age-adjusted hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.30 to 2.17; P < 0.0001). After adjustment for cardiovascular risk factors, participants with hostility scores in the highest quartile had a 58% greater risk of secondary events than those in the lowest quartile (HR: 1.58, 95% CI: 1.19 to 2.09; P = 0.001). This association was mildly attenuated after adjustment for C-reactive protein (HR: 1.41, 95% CI, 1.06 to 1.87; P = 0.02) and no longer significant after further adjustment for smoking and physical inactivity (HR: 1.25, 95% CI: 0.94 to 1.67; P = 0.13).

CONCLUSIONS

Hostility was a significant predictor of secondary events in this sample of outpatients with baseline stable CHD. Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.

Anger and the heart: perspectives on cardiac risk, mechanisms and interventions

In the popular imagination, anger has long been linked to cardiovascular diseases (CVD), but empirical validation from case-control and prospective studies emerged only in the 1970's. After describing the multidimensional nature of anger and its assessment (via self-report or observed in structured interviews), this paper selectively reviews evidence in (a) behavioral epidemiology, (b) stress and biological processes with implications for cardiopathogenesis, and (c) behavioral/pharmacological interventions for anger/hostility reduction. Although evidence is inconsistent, chronic feelings of anger, cynical distrust and antagonistic behavior are at least modestly associated with risk of both initiation and progression of CVD. Anger/hostility also is linked to stress exposure and reactivity, exaggerated autonomic function, reduced heart rate variability, platelet aggregation and inflammation. Clinical and pharmacologic treatment of anger/hostility has the potential to reduce anger and its health-damaging effects. Limitations, including third-variable explanations and overlap among the negative emotions, and implications for cardiology and behavioral medicine research and practice are discussed.

Observed hostility and the risk of incident ischemic heart disease: a prospective population study from the 1995 Canadian Nova Scotia Health Survey

OBJECTIVES

The aim of this study was to examine the relation between hostility and incident ischemic heart disease (IHD) and to determine whether observed hostility is superior to patient-reported hostility for the prediction of IHD in a large, prospective observational study.

BACKGROUND

Some studies have found that hostile patients have an increased risk of incident IHD. However, no studies have compared methods of hostility assessment or considered important psychosocial and cardiovascular risk factors as confounders. Furthermore, it is unknown whether all expressions of hostility carry equal risk or whether certain manifestations are more cardiotoxic.

METHODS

We assessed the independent relationship between baseline observed hostility and 10-year incident IHD in 1,749 adults of the population-based Canadian Nova Scotia Health Survey.

RESULTS

There were 149 (8.5%) incident IHD events (140 nonfatal, 9 fatal) during the 15,295 person-years of observation (9.74 events/1,000 person-years). Participants with any observed hostility had a greater risk of incident IHD than those without (p = 0.02); no such relation was found for patient-reported hostility. Those with any observed hostility had a significantly greater risk of incident IHD (hazard ratio: 2.06, 95% confidence interval: 1.04 to 4.08, p = 0.04), after adjusting for cardiovascular (age, sex, Framingham Risk Score) and psychosocial (depression, positive affect, patient-reported hostility, and anger) risk factors.

CONCLUSIONS

The presence of any observed hostility at baseline was associated with a 2-fold increased risk of incident IHD over 10 years of follow-up. Compared with patient-reported measures, observed hostility is a superior predictor of IHD.

[Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment]

Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.

[Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment]

Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.

Central nervous system serotonin and clustering of hostility, psychosocial, metabolic, and cardiovascular endophenotypes in men

OBJECTIVE

To use measures of cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5HIAA) and genotype of a functional polymorphism of the monoamine oxidase A gene promoter (MAOA-uVNTR) to study the role of central nervous system (CNS) serotonin in clustering of hostility, other psychosocial, metabolic and cardiovascular endophenotypes.

METHODS

In 86 healthy male volunteers, we evaluated CSF levels of the primary serotonin metabolite 5HIAA and MAOA-uVNTR genotype for association with a panel of 29 variables assessing hostility, other psychosocial, metabolic, and cardiovascular endophenotypes.

RESULTS

The correlations of 5HIAA with these endophenotypes in men with more active MAOA-uVNTR alleles were significantly different from those of men with less active alleles for 15 of the 29 endophenotypes. MAOA-uVNTR genotype and CSF 5HIAA interacted to explain 20% and 22% of the variance, respectively, in scores on one factor wherein high scores reflected a less healthy psychosocial profile and a second factor wherein high score reflected increased insulin resistance, body mass index, blood pressure and hostility. In men with less active alleles, higher 5HIAA was associated with more favorable profiles of hostility, other psychosocial, metabolic and cardiovascular endophenotypes; in men with more active alleles, higher 5HIAA was associated with less favorable profiles.

CONCLUSIONS

These findings indicate that, in men, indices of CNS serotonin function influence the expression and clustering of hostility, other psychosocial, metabolic and cardiovascular endophenotypes that have been shown to increase risk of developing cardiovascular disease. The findings are consistent with the hypothesis that increased CNS serotonin is associated with a more favorable psychosocial/metabolic/cardiovascular profile, whereas decreased CNS serotonin function is associated with a less favorable profile.

Cholesterol, triglycerides, and the Five-Factor Model of personality

Unhealthy lipid levels are among the leading controllable risk factors for coronary heart disease. To identify the psychological factors associated with dyslipidemia, this study investigates the personality correlates of cholesterol (total, LDL, and HDL) and triglycerides. A community-based sample (N=5532) from Sardinia, Italy, had their cholesterol and triglyceride levels assessed and completed a comprehensive personality questionnaire, the NEO-PI-R. All analyses controlled for age, sex, BMI, smoking, drinking, hypertension, and diabetes. Low Conscientiousness and traits related to impulsivity were associated with lower HDL cholesterol and higher triglycerides. Compared to the lowest 10%, those who scored in top 10% on Impulsivity had a 2.5 times greater risk of exceeding the clinical threshold for elevated triglycerides (OR=2.51, CI=1.56-4.07). In addition, sex moderated the association between trait depression (a component of Neuroticism) and HDL cholesterol, such that trait depression was associated with lower levels of HDL cholesterol in women but not men. When considering the connection between personality and health, unhealthy lipid profiles may be one intermediate biomarker between personality and morbidity and mortality.

Association of salivary cortisol circadian pattern with cynical hostility: multi-ethnic study of atherosclerosis

OBJECTIVE

To determine if cynical hostility is associated with alterations in diurnal profiles of cortisol. Hostility has been linked to cardiovascular disease but the biological mechanisms mediating this association remain unknown.

METHODS

Up to 18 measures of salivary cortisol taken over 3 days were obtained from each of 936 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Cynical hostility was measured using an eight-item subscale of the Cook-Medley Hostility Scale. Cortisol profiles were modeled using regression spline models that incorporated random parameters for subject-specific effects. Models were adjusted for race, sex, age, socioeconomic position, and lifestyle factors. The association of cynical hostility with key features of the cortisol diurnal profile, both in the full sample and important subsamples, was examined.

RESULTS

Waking cortisol levels as well as the extent of the morning surge in cortisol levels did not differ significantly across tertiles of cynical hostility. Respondents in the lowest tertile of cynical hostility experienced a 22% sharper decline in salivary cortisol (age- and sex-adjusted slope of -0.49 microg/dL per hour) than respondents in the highest tertile (-0.40 microg/dL per hour, p for difference = .0004). Intertertile differences in these parameters remained unaltered after further adjustment for potential confounders. This pattern of differences in cortisol diurnal profile tended to be related in a dose-response way to level of cynical hostility, and persisted in stratified analyses.

CONCLUSIONS

Cynical hostility is associated with the declining phase of the awakening cortisol response. The implications of this for cardiovascular and other health outcomes remain to be determined.