Extent of Coronary Atherosclerosis, Type A Behavior, and Cardiovascular Response to Social Interaction

It has been hypothesized that increased hemodynamic reactivity to psychological challenge in Type A individuals might be one important factor in specifically promoting the onset or progression of coronary artery disease (CAD). This study sought to test this notion by relating the extent of documented atherosclerosis to cardiovascular responses to challenging social situations. Eighty-three patients scheduled for cardiac catheterization were given a structured Type A interview and a history quiz while heart rate and blood pressure were monitored. Analyses controlling for age and beta-adrenergic blocking medications revealed some evidence of Type A-B differences in systolic blood pressure, heart rate, and rate-pressure product during the interview, but not during the quiz. More importantly for the aim of the study, there was little systematic evidence that magnitude of response on any of the cardiovascular measures was positively related to severity of CAD. Internal analyses of 24 non-medicated patients and examination of data derived from cardiac catheterization were used to rule out the possible confounding effects of beta-blocking drugs and myocardial damage. Results of this study do not provide evidence for a direct linkage between blood pressure or heart rate responses and the atherosclerotic process in coronary arteries. Limitations of the present study are discussed, and it is suggested that hemodynamic reactivity may be specifically linked to clinical manifestations of coronary heart disease via mechanisms other than acceleration of the atherosclerotic process.