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FRIDAY, July 25, 2003 (HealthDayNews) -- Aggressive, impatient Type A behavior doesn't seem to increase a man's overall risk of a heart attack, but it does appear to make the attacks happen earlier, a Welsh study finds.
Men who tested positive for Type A behavior on psychological tests had about the same risk of suffering a heart attack as their more placid counterparts, but they tended to have those attacks sooner, says a report in the July issue of Psychosomatic Medicine.
The trial was designed as yet another effort to look at the influence of behavior on cardiovascular risk, says study leader John E.J. Gallacher, a senior lecturer in epidemiology at the University of Wales College of Medicine.
After nine years, the incidence of heart attacks -- 12 percent -- was the same for the 538 men who tested positive for Type A behavior and those who didn't, Gallacher says. But the incidence of heart attacks dropped after the fifth year, he says. A complex statistical analysis showed that the lower incidence occurred primarily in the non-Type A men, meaning that those with Type A had their attacks earlier.
"In this study, the association of Type A with coronary heart disease is not whether, but when," Gallacher says.
The finding adds a twist to the sometimes controversial relationship between Type A behavior and heart disease, which was first described in 1958 by Dr. Meyer Friedman of the University of San Francisco, working with Dr. Ray Rosenman.
Several studies have found no increased risk of heart attacks in Type A men, but three major studies conducted by Friedman, one financed by the federal government, found a definite link. Friedman attributed the negative results of the other trials to a failure to test men's behavioral patterns properly.
Friedman died in 1990 at the age of 90. He headed an institute at the University of San Francisco that bears his name and carries on his work.
"We think we're tapping into the time-urgent element rather than the hostility element of Type A behavior," Gallacher says. That impatient behavior can accelerate the effect of cardiovascular risk factors, he explains.
"If your arteries are reasonably healthy, being time-urgent is irrelevant," Gallacher says. "If your arteries are diseased, the more time-urgent you are, the more likely you are to expose yourself to circumstances that cause vascular failure."
That analysis fits in with Friedman's feelings, says Wes Alles, a senior research scientist at Stanford University who does work on Type A behavior.
"Friedman would say that inmates at San Quentin didn't die of heart attacks," Alles says. "Time was no longer important to them."
But there has been "some academic debate about whether it is time-urgency or hostility that is to blame," he says. "My feeling is that the two go together. Frustration puts you in a struggle mood."
"You need to make time your friend," Alles notes. "If not, you have a powerful enemy."
More information
You can learn about the Type A story from its discoverer, Dr. Meyer Friedman. Assess your own risk for heart disease with a tool from the American Heart Association.
