ABSTRACT
During the 1950s, two cardiologists, Dr. Meier Friedman and Dr. Ray Rosenman, identified a constellation of behaviors as risk factors for coronary heart disease (CHD). These putative coronary-prone behaviors are intense ambition, hard-driving job involvement, competitiveness, impatience, a chronic sense of time urgency, hostility, and aggression. For descriptive purposes, this behavior pattern was labeled Type A (Friedman & Rosenman, 1974). In a more general sense, the Type A individual has been described as someone who is in constant competition with his fellow men and with time; he or she has been contrasted with the Type B individual, who leads a much more relaxed life-style (Friedman & Rosenman, 1974; Rosenman & Friedman, 1974). Friedman and Rosenman also developed a structured interview (SI) for the assessment of the Type A behavior pattern (TABP). The questions in this interview focus on the respondent's hard-driving, competitive, time-urgent, impatient, and hostile behaviors (Rosenman, 1978) and are interspersed with occasional challenging remarks such as Why?, Why not?, Never?, and Always? Perhaps the most convincing evidence for the proposition that the Type A behavior pattern is a significant risk factor for CHD emerged from the Western Collaborative Group Study (WCGS). This was a large-scale prospective study involving 3,154 men, and in which Type A's, as assessed by the SI, were more than twice as much at risk for myocardial infarctions (MIs) and other clinical manifestations of CHD than Type B's, independent of the traditional risk factors such as smoking, overweight, cholesterol level, etc. (Brand, 1978; Rosenman et al., 1975). The amount of risk association with the TABP was approximately equal to that conferred by the other risk factors, and the TABP predicted incidence of CHD regardless of the presence or absence of any combination of the traditional risk factors (Brand, 1978). Supportive evidence also came from studies that found significant correlations between SI-derived TABP scores and the severity of angiographically documented coronary artery occlusion. These findings buttressed the link between the TABP and CHD (Blumenthal, Williams, & Kong, 1978; Frank, Heller, Kornfeld, Spoon, & Weiss, 1978; Friedman et al., 1968; Williams et al., 1980).
