Exercise hypertension: behavior and the dynamic action of risk factors.

Epidemiological research identifies risk factors for coronary heart disease (CHD) to enable interventions to reduce the incidence of the disease. The twenty-year decline in cardiovascular-related deaths, however, cannot be explained solely by any pronounced changes in the classic risk factors (serum cholesterol, blood pressure and cigarette smoking) or related behaviors. Accordingly, it is apparent that there is much unexplained variance in the pathophysiology of CHD and that various behaviors are not associated with the classic risk factors in a simplistic fashion. Since acute and severe stress can affect thresholds for precipitation of cardiac events, the question of causality of long-term negative emotions has been repeatedly addressed; there is, however, no solid evidence that facets of neuroticism are related to documented acute coronary events while on the other hand, there is considerable evidence that emotionally maladjusted individuals have many complaints, including chest pain that is frequently labeled angina in spite of the absence of documented CHD. With regard to patterns of behavior in identifying risk factor status in CHD most attention has been focused on the Type A behavior pattern (hard-driving, job involvement, speed of activity, competitiveness, aggressiveness and mental and physical alertness). While this type of behavior has been related to clinical CHD independent of classic risk factors in some studies, the vast majority of epidemiological research has failed to replicate the association between the global Type A behavior pattern and any manifestation of CHD. Some attributes of the Type A behavior pattern, in particular, hostility, however, may be related to CHD even if the global pattern is not significantly associated.(ABSTRACT TRUNCATED AT 250 WORDS)