Personality traits and coronary heart disease. Utilization of a cross-sectional study design to test whether a selected psychological profile precedes or follows manifest coronary heart disease

The present study was designed to test the hypothesis that a distinctive psycholgical pattern consisting of a low level of manifest hostility with elevated levels of anxiety and repression is associated with coronary heart disease and precedes its occurrence. The findings of the Epidemiological Survey in Evans County, Georgia (1960-1962) were utilized in part for this project. White males between the ages of 40 and 74 were classified according to selected levels of blood pressure and serum cholesterol into three risk groups: (1) Low-risk: composed of individuals with reduced levels of both blood pressure and serum cholesterol; (2) Moderately-high-risk: composed of individuals with elevated levels of either blood pressure or serum cholesterol; and (3) High-risk: composed of individuals with elevated levels of both blood pressure and serum cholesterol. Persons diagnosed as coronary disease patients (1960-1962) made up the coronary group of this project. Samples, comparable with the coronary group in age and social class, were obtained from the low-risk and the moderately-high-risk groups. All men who met the criteria of the high-risk group were included in the study. A psychological test was administered to each respondent in the defined sample keeping the identity of each of the study groups concealed from the investigator. The psychological test was composed of the Anxiety Scale, the Repression Scale and the Lie Scale of the MMPI, as well as a Manifest Hostility Scale. A profile analysis of the three psychological variables-hostility, anxiety, and repression-has proved most useful in differentiating the coronary from the noncoronary groups. Two-thirds of the coronary group, in contrast to one-fifth of the non-coronary groups, were found to exhibit a selected psychological pattern comprising a low level of manifest hostility with elevated levels of anxiety and repression in the individual. There was no increasing gradient for the proportion of individuals with the selected pattern from the low-risk through the moderately-high-risk to the high-risk groups. Utilizing a system of interpretations from cross-sectional data, these findings led to the inference that the selected pattern probably followed the onset of coronary heart disease.