Analysis of A type behavior pattern and anger profiles in patients with coronary heart disease

Title: Analysis of A Type Behavior Pattern and Anger Profiles in Patients with Coronoray Heart Disease Introduction: The causes of many health problems are based on behavioral styles in nowadays. Therefore it is important to understand psycho-social, biochemical and genetic factors involved in health-related behaviors. Behavioral styles with consistent and periodical patterns are related to personality traits. In recent years, the associations between personality based behavioral traits and well being are getting stronger. Especially, the strong correlations between stress, A type behavior pattern, anger profiles and coronary heart diseases indicate that patterns of A type behavior and anger profiles are important risk factors as much as high lipid profiles, smoking and sedentary lifestyles. Objective: The first aim was to calibrate A type measure of ERCTA and anger profiles measure of STAXI-2 inventories into Turkish population in order to investigate the role of A type behaviour and anger profiles in Turkish patients with coronary heart diseases (CHD). The second aim was to find out the frequency of A and B type behavior patterns and their association with coronary heart diseases by designing patient group from population of coronary heart diseases in Manisa province. The third aim was to determine what components of anger have displayed the significant differences in high A and B type subcategories of patients comparing to control ones. The fourth aim was to compare the anger scores of patients to ones of control group by forming subcategories of A type behavior pattern and anger profile. Material and Methods: A total of 162 patients (75 males, 87 females) were participated in the study who applied to Cardiology Department of School of Medicine of Celal Bayar University and Cardiology Service of Private Manisa Vatan Hospital. A total of 172 control groups (59 males, 113 females) who live in Manisa, İzmir and around the cities were participated in the study. All of the patients diagnosed by cardiologists were divided incidentally into two groups, being coronary artery diseases (CAD) (N=66; 46 males, 20 females) and mitral valve prolapsus (MVP) (N=96; 29 males, 67 females). They were assessed with ERCTA.TR for A type behaviour pattern and with STAXI-2.TR for anger profiles. The 1522 (for ERCTA.TR) and 1421 (for STAXI-2.TR) volunteers, who live in Manisa, İzmir and around the cities, have taken both inventories for calibration and validity studies. The frequency of A type behavioral categories of patients and controls were analyzed by using chi-square (X2). The values of anger components in subcategories of A type behaviour pattern in patient group were compared by themselves and control ones by using ANOVA and Post-hoc test (Student-Newman-Keuls). All data analysis were done by statistical softwares such as Kaleidagraph 4.02, GraphPad Prism 5.0 and SPSS 12.0. Results: Croanbach?s alpha values of ERCTA.TR and STAXI-2.TR inventories were found to be 0.660 and 0.644-0.892 respectively in validity and reliability studies. These values were interpreted that ERCTA.TR and STAXI-2.TR can be used reliably in Turkish populations studies. The frequency of A type behavioral pattern was significantly different between CAD patients and control groups (p<0.05). It was interpreted that A type behavior is a risk factor for coronary heart diseases. It was also found that state anger and anger index scores of patients with both high A and B type behavior were significantly different within both subgroups and control ones (p<0.0001). However, there was no meaningful difference in trait anger scores between patient and control groups (p>0.05). Mean value (37,04) of anger index in male controls with A type behavior pattern was higher than the one of male patients (30,35). This interesting data was interpreted that those with low score of anger index supress their anger so that their expressing anger index is low. The allostatic load of heart as an outcome is increased since high level of anger and its supression cause to excess activation of sympathetic neural system. All data implies that high A and A type behavior patterns, high scores of state (S-Ang), trait (T-Ang) anger and anger index (Ax-index) are risk factors in Turkish population by increasing susceptibility of having coronary heart diseases. Conclusion: It was confirmed that ERCTA.TR and STAXI-2.TR inventories have enough reliability and validity to analyze Turkish population and subpopulation of coronary heart diseases in terms of categorizing CAD patients based on A type behavior pattern and state and trait anger and anger index parameters. Patients with high A type behaviour (%92) was higher frequency than the patients with B type behaviour (%12). It was observed that those with high values of state and trait anger and anger index in the patients group have formed distinct subgroups. There was also another patient group with B type behavioral pattern having low score of S-Ang, T-Ang and AX-Index. It was revealed that it is not sufficient to use only A type behavior pattern scale in the investigation of mediating role of behavioral styles in coronary heart diseases. Therefore multiplex inventories should be used such as ERCTA.TR and STAXI-2.TR. It was reconfirmed that the risk factors related to coronary heart diseases was not limited to biochemical parameters, and emotion colored behavioral patterns based on genetic-memetic heritage are also significant risk factors. Key words: A type behavior pattern, ERCTA.TR, Anger, STAXI-2.TR, Coronary Heart Disease, Coronary Artery Disease, Mitral Valve Prolapsus