Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Drs Williams and Barefoot), Medicine (Dr Williams), and Psychology (Dr Williams), and the Behavioral Medicine Research Center (Dr Williams), Duke University Medical Center (Drs Williams and Barefoot), Durham, NC; and Departments of Psychology, Medicine, and Psychiatry, and the Behavioral Medicine Research Center, University of Miami, Miami, Fla (Dr Schneiderman).
Solid scientific evidence supporting the adverse effects of stress on
health began to emerge nearly 30 years ago with the report by Rosenman et
al1 showing that men with type A behavior (time
urgency, hostility, achievement striving) were twice as likely as their counterparts
with type B behavior (lacking type A characteristics) to develop coronary
heart disease (CHD) over an 8-½ year period.1 Failure
to replicate this finding in another large-scale prospective study2 raised questions about the validity of type A behavior
as a CHD risk factor. However, subsequent research makes a strong case that
of the 3 components of the global type A behavior pattern, hostility is the
one most reliably associated with increased CHD risk.3-5
Williams RB, Barefoot JC, Schneiderman N. Psychosocial Risk Factors for Cardiovascular Disease: More Than One Culprit at Work. JAMA. 2003;290(16):2190–2192. doi:10.1001/jama.290.16.2190
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