Coronary-prone behavior: one pattern or several?

A cohort of 2750 healthy men who responded to a 61-item questionnaire was studied prospectively for 4 years, by which time 67 sustained acute myocardial infarctions (AMI), 30 were discovered by ECG to have had myocardial infarctions, which had gone clinically unrecognized ("silent") (SMI), and 23 had developed classical angina pectoris without ECG changes indicative of infarction. Item analysis of the questionnaire using multi-group optimal scaling and discriminant function revealed the patterns of responses to be characteristically different among the three clinical presentations of coronary disease and those men who remained healthy. The psychological properties of the three significant dimensions of discrimination are discussed. A second study, involving largely healthy men from the same population, supported the inference that the dimensions isolated were statistically and psychologically genuine. The implication is that different facets of the coronary-prone Type A behavior pattern may be specifically associated with different clinical manifestation of coronary disease. Refinement of these dimensions may lead to more specific prediction of coronary disease risk in the future.