Spouse behavior and coronary heart disease in men: prospective results from the Framingham heart study. II. Modification of risk in type A husbands according to the social and psychological status of their wives.

Analyses of spouse data from the Framingham Heart Study indicated that the risk of developing coronary heart disease among Type A men, compared with Type B men, was modified by the behavior or social status of their wives. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. When Type A and Type B men were stratified by the social and personality characteristics of their wives, it was found that the differential rate of heart disease between Type A and Type B men was present only in situations where the wives' characteristics might be deemed stressful. Type A husbands were 2.5 times as likely to develop coronary heart disease as Type B husbands if married to women with 13 or more years of education, and had 3.5 times the coronary risk of Type B husbands if married to a woman employed outside the home. When spouses were stratified by behavior type, employed outside the home. When spouses were stratified by behavior type, the highest rates of coronary heart disease were among Type A men married to Type B wives (25%). This rate was over three times the rate among Type B men married to Type B wives (7.8%). When tests for interaction between the behavior type of husbands and characteristics of wives were calculated, significant effects were found among blue-collar men on all variables except wives' educational level. This indicates that Type A men in white-collar occupations are at higher risk of heart disease regardless of wives' characteristics; whereas, the effect of behavior type among men in blue-collar occupations was interrelated with and modified by wives' characteristics. These results were apparent regardless of the husbands' standard coronary risk factors.