In sharp contrast to earlier findings, recent retrospective and prospective epidemiological research has failed to find any association between the global Type A behavior pattern (TABP) and clinical manifestations of coronary heart diseaase (CHD). However, the same retrospective findings clearly suggested that assessment of specific attributes of the TABP such as the hostility/anger dimension can yield a significant positive relationship with CHD even though global TABP is not significant in its association. Such findings guided the development of a matched case-control design in which component reanalysis of structured interviews (SIs) in the prospective Multiple Risk Factor Intervention trial (MRFIT) showed a significant positive association between the hostility dimension and incidence of CHD in the complete absence of a signifcant effect for global TABP. Interestingly, both traditional risk factors and the hostility dimension showed pronounced effects only in younger relative to older participants. The proposed research seeks to further refine assessment of facets of hostility in an effort to demonstrate that the antagonistic style of interaction facet of hostility is associated with documented CHD whereas neuroticism and the neurotic facet of hostility are not related to or inversely associated with """"""""hard"""""""" CHD endpoints, but positively associated with the """"""""soft"""""""" (angina only) endpoint. In this connection, the differential relationships of facets of hostility and nueroticism with all forms of nonCHD-related mortality will also be investigated in MRFIT. A second prospective study, Western Collaborative Group study (WCGS), which already had been used to crossvalidate the findings uncovered in MRFIT, will provide additional SIs to test the hypothesis that ratings of antagonistic hostility are predictive of the incidence of CHD even in the absence of specific questions calling for content of answers related to hostility. Also,a theoretically and empricially-based rating scale will be used in addition to the current component scoring procedures in an effort to more objectively assess various facets of hostility and neuroticism. Finally, both MRFIT and a third prospective study, Baltimore Longitudinal Study of Aging (BLSA), will make possible exploration of whether particular biobehavioral profiles are associated with differnet facets of hostility and neuroticism. Finally, both MRFIT and a third prospective study, Baltimore Longitudinal study of Aging. (BLSA), will make possible exploration of whether particular biobehavioral profiles are associated with different facets of hostility andd neuroticism. The addition of BLSA also will allow use of mutiple methods of assessment including the addition of new hostility- related items to the SI for future examination of prospective relationships with disease endpoints.
