Psychological Predictors of Heart Disease: A Quantitative Review

After 3 decades of intensive research, there is still confusion about the nature and reliability of relations between psychological factors and coronary heart disease (CHD). A meta-analysis, or quantitative review, was performed to integrate and organize the results of studies that investigated certain personality variables in relation to CHD. The personality variables included were anger, hostility, aggression, depression, extroversion, anxiety, Type A, and the major components of Type A. The meta-analytic framework helps focus attention on issues needing clarification. The results indicate that modest but reliable associations exist between some of the personality variables and CHD. The strongest associations were found for Type A and, surprisingly, for depression, but anger/hostility/aggression and anxiety also related reliably to CHD. The Structured Interview diagnosis of Type A was shown to be clearly superior to the Jenkins Activity Survey as a predictor of CHD. The Type A-CHD relation was smaller in prospective than in cross-sectional studies and smaller in recent than in less recent studies. This review also revealed that information about the interrelations of personality predictors of CHD is sorely needed. The picture of coronary-proneness revealed by this review is not one of a hurried, impatient workaholic but instead is one of a person with one or more negative emotions. We suggest that the concept of the coronary-prone personality and its associated research be broadened to encompass psychological attributes in addition to those associated with Type A behavior and narrowed to eliminate those components that the accumulated evidence shows to be unimportant.