The relationship of psychosocial factors to coronary heart disease in the Framingham study. I. Methods and risk factors.

Questionnaires administered to 1822 members of the Framingham Heart Study from 1965 to 1967 provided measures of personality type, sociocultural mobility, situational stress and somatic strain. Clusters of questions selected by a panel of experts, and verified by item and factor analysis, formed scales of Type A behavior and other psychosocial states. The Framingham Type A behavior scale was significantly correlated with daily stress (.47), emotional lability (.43), tension (.42), anger symptoms (.34), and ambitiousness (.31). Women were less likely than men to be ambitious and to exhibit the Framingham Type A behavior, and were more likely than men to be emotionally labile, tense, and to suppress hostility. Few consistent associations were found between psychosocial stress measures and levels of blood pressure or cholesterol. Social status and marital conflicts were significantly associated with patterns of smoking. The Framingham Type A behavior pattern and other psychosocial measures were not related to the level of CHD risk, as determined by the Framingham logistic equations.