ABSTRACT
A growing literature, much of which is reviewed in this volume, demonstrates that behavioral attributes of individuals contribute to the development and clinical expression of coronary heart disease (CHD) (Manuck, Kaplan, & Matthews, 1986). Associated prominently with an increased risk for CHD in prospective studies of initially healthy individuals is the well-known Type A behavior pattern. Moreover, of the several dispositional characteristics that define Type A behavior, it now appears that a high “potential for hostility” and related aspects of anger and its expression most strongly predict subsequent coronary disease. These epidemiologic associations have also been found, on multivariate analysis, to be independent of concomitant variability in such standard CHD risk factors as hyperlipoproteinemia, hypertension, cigarette smoking, and age. In turn, the latter findings have generated much speculation regarding physiologic mechanisms that may mediate psychosocial influences on coronary disease (Manuck & Krantz, 1986). In this respect, it is widely hypothesized that pronounced or recurrent hemodynamic reactions to behavioral stimuli heighten CHD risk, perhaps by precipitation of acute clinical events or by an exacerbation of coronary artery atherosclerosis. This possibility, as well as potential pathogenic effects associated with patterns of neuroendocrine response to stress (such as an increased release of the catecholamines and corticosteroids) are discussed at length by Dr. Williams in Chapter 9. Our objective in this chapter is to consider, more specifically, individual differences in cardiac responsivity to stress, as these are related to both coronary artery atherosclerosis and social behavior in a nonhuman primate model of atherogenesis. The research summarized here is based on recent studies conducted at the Arteriosclerosis Research Center of Bowman Gray School of Medicine, Wake Forest University. Because we have observed that patterns of association among the variables studied differ as a function of animals' sex, results of investigations involving male and female monkeys are described separately here. Finally, we conclude the chapter with a brief discussion of hemodynamic parameters in atherogenesis; here we propose, as a working hypothesis, that arterial flow disturbances evoked by behavioral stimuli serve to promote endothelial injury, an early stage in the development of atherosclerosis.
