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Editorial |

Psychosocial Risk Factors for Cardiovascular Disease:  More Than One Culprit at Work

Redford B. Williams, MD; John C. Barefoot, PhD; Neil Schneiderman, PhD
JAMA. 2003;290(16):2190-2192. doi:10.1001/jama.290.16.2190.
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Solid scientific evidence supporting the adverse effects of stress on health began to emerge nearly 30 years ago with the report by Rosenman et al1 showing that men with type A behavior (time urgency, hostility, achievement striving) were twice as likely as their counterparts with type B behavior (lacking type A characteristics) to develop coronary heart disease (CHD) over an 8-½ year period.1 Failure to replicate this finding in another large-scale prospective study2 raised questions about the validity of type A behavior as a CHD risk factor. However, subsequent research makes a strong case that of the 3 components of the global type A behavior pattern, hostility is the one most reliably associated with increased CHD risk.35

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