Behavioral Risk Factors in Coronary Artery Disease

The belief that personality, emotions, and disturbing life experiences play a part in the development of c ardiovascular disease s is widely held, both by t he general public and by the medical practitioners who treat their illnesses. This possible association is treated with great skepticism, however, by many of those aca­ demic and research physicians and biologists who are more laboratory or statis­ tically oriented. Consensus between practitioners and researchers is slow in developing, not because the clinical observations lack merit, but because of the great difficulty of defining and measuring psychosocial and behavioral concepts. This, in turn, has delayed the rigorous research that is essential to distinguish fortuitous observations from genuine patterns in nature. Recently, more rig­ orous epidemiological study designs and more quantitative techniques for as­ sessing psychological and social factors have permitted substantial scientific progress. The role of psychosocial and behavioral factors in cardiovascular disease, particularly in coronary artery disease (CAD), has already become important to the teacher of medicine, and may soon take on sufficiently valid operational forms as to be of utility to the medical practitioner. This review focuses first on that segment of social-behavioral resear�h into the etiology of CAD that we believe to be currently the most advanced-that dealing with the coronary-prone behavior pattern (Type A). We then review additional psychosocial risk factors whose association with CAD has been shown repeatedly, and finally, close with discussion about implications for medical education and practice.