The broad objectives of the research to be done on this ADAMHA RSA are: 1) to identify psychological traits responsible for the increased coronary heart disease (CHD) risk among Type A persons; 2) to identify biological mechanisms mediating this increased CHD risk; and 3) to use the knowledge gained to devise effective prevention and treatment measures. Two general programs of research will be mounted to achieve these goals. Epidemiological studies will be done to refine a hostility/cynicism scale which appears to predict a broad range of adverse health outcomes; and to establish its construct validity. Along with measures of Type A, anger exprience and anger expression, a questionnaire containing hostility/cynicism items will be administered to healthy groups and to patients undergoing coronary angiography. If correlations with other measures suggest construct validity for the new cynicism scale and if it predicts CHD events and accounts for the relation of Type A to coronary atherosclerosis (CAD), the first objective will be achieved. A series of biobehavioral studies will be done comparing cardiovascular and neuroendocrine responses of Type A and B men to tasks requiring sensory intake versus mental work behavior. The generalizability of lab findings to real life will be evaluated by obtaining 24hr urine samples on these subjects and seeing if lab neuroendocrine responses predict urinary excretion levels. Statistical analyses will evaluate the effect of hostility/cynicism levels and aging on the observed responses, both in the lab and natural settings. Persistent hyperresponsivity among men with more severe CAD will be evaluated and if present would support pathogenic involvement of such hyperresponsivity. Behavioral paradigms which elicit the same neuroendocrine response patterns in the rat will be evaluated with the goal of showing that such response patterns are capable of potentiating atherogenesis in an animal model. The effects of beta-blockers and benzodiazipines on both humans' and rats' responses to the behavioral paradigms will be evaluated, both to learn more about mechanisms of the responses and to begin to devise intervention approaches. Collaboration in doing this research with established investigators in the relevant areas will contribute to the professional growth of the Principal Investigator. Successful completion of the proposed studies will result in substantial progress toward identifying the key psychological trait(s) predisposing to increased CHD risk among Type A persons, as well as the intervening biological mechanisms. Such knowledge will contribute to development of effective prevention and treatment approaches.
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