The objective is to elucidate the role of biobehavioral factors in the etiology, pathogenesis, and course of coronary heart disease (CHD). In Project 1 a broad range of measures of the hostility/cynicism/anger/mistrust (HCAM) domain of Type A behavior will be assessed in patients undergoing coronary angiography. The best set of HCAM measures which correlate, independently of other risk factors, with coronary atherosclerosis (CAD) will be identified. These measures will be among those evaluated as predictors of CHD outcomes and new CHD events in Project 2-4, and the biological correlates of these measures will be determined in Project 5. In Project 2 HCAM and other psychosocial data will be obtained in angiographic patients to identify a set of predictors of important CHD outcomes: return to work, morbidity and mortality. In Project 3 we shall collect data on HCAM status, urinary hormonal excretion, and cardiovascular reactivity in patients undergoing coronary angioplasty (PCTA), to identify biobehavioral factors predictive of restenosis in this unique clinical sample. In Project 4 we shall collect HCAM, other psychosocial data, health data, and data on current health behaviors in a sample of 6,000+ college graduates on whom MMPI-based HCAM data is available from their freshman orientation 20 years ago. [We seek to show here that HCAM traits are prospectively associated with increased CHD risk in this sample, who will be followed in a prospective study over the next 10 years, thus providing evidence that HCAM traits cause CHD.] In Project 5, we shall evaluate psychoendocrine correlates of CAD severity and HCAM status in both patients and normals. We shall also evaluate the psychobiological correlates of increased beta receptor sensitivity, as indexed by EKG T-wave suppression during isoproterenol infusions. In Project 6 the Egyptian sand rat will be used as a model of atherosclerosis to evaluate the effect on atherogenesis of behavioral and pharmacologic maneuvers to mimic the neuroendocrine patterns found to correlate with HCAM status, CAD severity, and beta receptor sensitivity in Project 5. The knowledge gained in this research program will increase our understanding of how biobehavioral factors affect the etiology, pathogenesis, and course of CHD. This knowledge will result in more effective and efficient approaches to the prevention, treatment, and rehabilitation of CHD, the nation's number 1 killer.
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