PROSPECTIVE EPIDEMIOLOGICAL RECOGNITION OF CANDIDATE FOR ISCHEMIC HEART DISEASE

An increased incidence of clinical coronary heart disease (CHD) occurs in industrialized societies characterized by habitual physical inactivity, excessive dietary fat and modern socioeconomic stresses, and therein in individuals with attributes such as heavy cigarette smoking, hypertension, diabetes, and higher serum lipids. Nevertheless, groups of CHD victims prospectively show no differences of diet or exercise and only relatively small differences of mean smoking, blood pressure and serum lipids com pared to groups without CHD. Moreover, the majority of men exhibiting these risk factors remain free of CHD, and conversely, most victimized subjects are not prospectively characterized by such attributes. These discrepancies are explained in large part by the overt behavior pattern. Men with enhanced aggressiveness, competitiveness, drive for achievement, and chronic sense of time urgency exhibit the Type A be havior pattern. This is associated with significantly increased incidence of CHD, regardless of whether other risk attributes are present or absent. Men with the Type A behavior pattern exhibit the biological concomitants found in men with already present CHD. Men without such behavioral characteristics (Pattern B) who posses serum lipids at or below mean levels for the population are strikingly immune to CHD regardless of the presence of any other risk attributes. © 1968 S. Karger AG, Basel.