Behavioral antecedents of coronary heart disease and atherosclerosis.
Behavioral antecedents of coronary heart disease and atherosclerosis.
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冠心病和动脉粥样硬化的行为前因。
DOI：
10.1161/01.atv.6.1.2
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Matthews,KA
中科院分区：
文献类型：
--
作者：
Manuck,SB;Kaplan,JR;Matthews,KA
回顾了50多项关于行为对动脉粥样硬化和冠心病影响的流行病学、临床和实验研究；在这些调查中，在1975年之前发表的不超过5项。尽管在这些相对年轻的文献中存在一些不一致和偶尔的概念和方法问题，但现有证据的优势表明，心理社会变量在冠状动脉疾病中起着重要作用。简而言之，在几乎所有对健康个体的前瞻性研究中，A型行为模式都被发现可以预测新发冠心病，并且A型行为模式的治疗性改变已被证明可以降低非致死性心肌梗死复发的风险。然而，在大多数对心肌梗死后患者和由于传统危险因素升高而导致冠心病高风险人群的前瞻性研究中，A型行为模式并没有分别预测心肌梗死复发或初始临床事件。此外，在少数研究中，A型个体在血管造影检查中比b型个体显示出更广泛的冠状动脉粥样硬化，并且通常仅在用SI测量A型行为的情况下。值得注意的是，许多临床研究可能存在缺陷，因为它们使用了小而异质性的患者样本，并且在选择和招募受试者时可能存在偏差。与全球定义的A型相反，在所有检查了这些变量的流行病学和临床研究中，高度潜在的敌意和无法或不愿意表达愤怒（anger- In）已成为冠状动脉疾病的重要预测因素或相关因素。这些一致的结果表明，对敌意和愤怒的倾向，以及对这些情绪的抑制表达，代表了a型人格模式的“有毒”成分。最近的一些前瞻性研究也表明，高水平的生活压力和拥有贫穷或不足的社会资源是冠心病的预测因素。然而，生活压力、社会网络和社会支持的概念以及这些变量之间的关系尚未得到很好的理解，需要进行大量额外的工作来确定社会环境的具体致病和保护属性。除了对人类冠心病的社会心理前因的研究外，现在也有一些关于行为对动物模型冠状动脉病变发展影响的研究发表。（摘要删节为400字）
Over 50 epidemiologic, clinical, and experimental studies of behavioral influences on atherosclerosis and CHD have been reviewed; of these investigations, no more than five were published prior to 1975. Despite some inconsistencies and occasional conceptual and methodologic problems in the studies comprising this relatively young literature, the preponderance of available evidence indicates that psychosocial variables play a significant role in coronary disease. To summarize briefly, the Type A behavior pattern has been found predictive of new CHD in nearly all prospective studies of initially healthy individuals, and therapeutic modification of Type A has been shown to reduce risk of recurrent nonfatal MI. Among most prospective studies of post-MI patients and of persons at heightened risk for CHD due to elevations in traditional risk factors, however, Type A has not been found to predict, respectively, recurrence of MI or initial clinical events. Additionally, Type A individuals have shown more extensive coronary artery atherosclerosis on angiographic examination than Type Bs in a minority of studies, and, generally, only where Type A behavior has been measured by the SI. It is noted that many of these clinical studies may be faulted, though, for their use of small and heterogeneous patient samples and for possible biases in the selection and recruitment of subjects. In contrast to the globally defined Type A pattern, a high potential for hostility and an inability or unwillingness to express anger (anger-in) have emerged as significant predictors or correlates of coronary disease in all epidemiologic and clinical studies in which these variables have been examined. These consistent results suggest that a predisposition to hostility and anger, and the inhibited expression of such feelings, represent a "toxic" component of the Type A pattern. Several recent prospective investigations indicate also that high levels of life stress and possession of poor or inadequate social resources are predictive of CHD. The concepts of life stress, social network, and social support, as well as relationships among these variables, are not well-understood, however, and much additional work is needed to identify specific pathogenic and protective attributes of the social environment. In addition to studies of the psychosocial antecedents of CHD in human beings, there now are several published studies of behavioral influences on the development of coronary lesions in animal models.(ABSTRACT TRUNCATED AT 400 WORDS)