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July 1986

The Coronary-Prone Behavior Pattern: Achievements and Missed Opportunities

Author Affiliations

From the Departments of Medicine (Dr R. I. Horwitz) and Epidemiology (Drs R. I. and S. M. Horwitz), Yale University School of Medicine, New Haven, Conn. Dr Sarah Horwitz is a fellow of the Institution for Social and Policy Study, Yale University.

Arch Intern Med. 1986;146(7):1429-1432. doi:10.1001/archinte.1986.00360190221032

Many great clinicians have believed that ischemic heart disease was inextricably linked to psychosocial factors. For example, Sir William Osler suggested that the cause of "arterial degeneration" would be found in "the worry and strain of modern life"; and William Harvey attributed a patient's heart disease to the observation that he "was overcome with anger and indignation which he yet communicated to no one." These descriptions are often echoed today by physicians and members of the public who believe that ischemic heart disease is caused, in part, by psychologic factors. Some of the strongest evidence linking psychosocial factors to ischemic heart disease comes from the studies of "type A" behavior pattern. Individuals with the type A pattern are described as aggressive, striving, ambitious, restless, and excessively concerned with time and deadlines. Individuals without these characteristics are classified as having the type B behavior pattern.

The principal

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