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October 22/29, 2003

Psychosocial Risk Factors for Cardiovascular Disease: More Than One Culprit at Work

Author Affiliations

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).

JAMA. 2003;290(16):2190-2192. doi:10.1001/jama.290.16.2190

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