A Surprising Risk Factor of Coronary Heart Disease

And no, it's not smoking or high blood pressure

Human heart with blood vessels. 3d illustration (Shutterstock)

• How many times have we heard the “smoking, drinking, and being overweight” warning in relation to heart disease? Yet, one of the longest-running studies contradicts this.
• A much bigger risk factor is stress—particularly the kind of stress found in a specific personality type that processes anger in a particular way.
• The Framingham project is the quintessential epidemiological population study, of more than 14,000 people across three generations. And a key piece of lifestyle advice is hidden in the 1980 analysis of the final cohort.
• Do you feel guilty if you use free time to relax? Ask yourself these “Type A” identifier questions, and check whether you also process stress in these same ways—this stress management protocol is a key driver of coronary heart disease.
• Physically, anger leads to catecholamine release, which has a host of cardiovascular repercussions. In “fight mode,” the liver synthesizes triglycerides in a boost of energy, which in turn contributes to lipid disorders.
• If this is you, there’s still no need to be fatalistic. These are behavior patterns that we can train and change, and changes start small. Rome wasn’t built in a day.

According to the National Center for Health Statistics, heart disease is the leading cause of death in the United States. One in five American deaths were due to heart disease in 2020, as reported by the Centers for Disease Control and Prevention (CDC). Worldwide, cardiovascular disease is also the leading cause of death year after year.

Coronary heart disease (CHD) is the most common type of heart disease, killing nearly 383,000 Americans in 2020. Scientists and the medical community are investing much time and money into the study of what keeps the heart healthy and what can stop it from beating.

Many risk factors have been suggested for CHD. Among these, high blood pressure, high blood cholesterol, and smoking have been assumed to be leading causes. Doctors wear themselves out by repeating the same warnings that CHD could be much reduced if people would reduce their bad cholesterol levels by eating healthy food and becoming active. People need to quit dangerous habits that further raise blood pressure such as the three best-known ones: smoking, being overweight, and drinking too much alcohol.

Stress on the heart is terribly bad for you, but it rarely makes the headlines. We all know stress remains unhealthy for both our body and mind, but do we listen? More importantly, do we take action to prevent stress from causing disease in our bodies?

Despite decades of studies, we like to point fingers at the usual subjects. Smoking has the worst reputation of all. How many times have you tried to convince a loved one that smoking may take their life one day? They tell you they do it to calm their nerves, right? You beg them to take a walk instead; you suggest exercise classes and fishing at the lake. You may have printed out studies to show them what those commercially-made cigarettes and nightly booze binges will do to them. Maybe you are helping them avoid the dreaded black lungs we’ve seen in health class photos.

Yet, hold on. We’re talking about heart disease here.

Smoking is bad for your health, and often times fatal in terms of lung disease. But one of the longest running studies on heart disease contradicts what we all assumed about smoking and CHD. In the study, smokers developed fewer cases of CHD than non-smokers.

A much bigger risk factor is not smoking, but stress—the kind of stress found in a particular personality type—and when left unchecked, the manifestation of it can be worse on the heart than smoking.

According to Dr. Yuhong Dong, medical doctor and Ph.D. in infectious diseases, there are many biological and energetic mechanisms occurring concurrently in CHD, but the Type A personality’s unhealthy expression of anger is what makes a larger imprint on our hearts and minds.

A Surprising Risk Factor of Coronary Heart Diseases (CHD)

A counterintuitive twist on smoking’s effect on CHD brings to mind the story of Batuli Lamichhane, one of the oldest women in the world, who told news reporters on her 112th birthday that the secret to a long life is smoking, as she had puffed away on 30 cigarettes a day since she was 17 years old. If her story was just an isolated story that would be one thing, but it’s not. There are stories about many of the oldest people in the world who smoke, drink, and eat to their hearts’ content.

The Framingham project, which began in 1948, is the quintessential epidemiological and largest population study of more than 14,000 people across three generations. The project ultimately found evidence that formed the textbook warning we hear at doctor visits: high blood pressure and high blood cholesterol are major risk factors for CHD. However, we have learned something else from the well-known Framingham Heart Study.

The key lifestyle advice is hidden in the 1980s analysis of the final cohort.

When researchers looked at the long-term patterns in the cardiovascular health of more than 5,000 male and female smokers and non-smokers, consisting of 2,282 men and 2,845 women aged 29 through 62 years (and free from CHD at the initial examination), they found little evidence that smoking is a risk factor for coronary heart disease (CHD).

“In these monumental studies and analysis, smokers and non-smokers showed no differences at all,” said Dr. Dong. “CHD is the product of many risk factors acting synergistically. There is no doubt that smoking is one of many risk factors, but its effects, acting by itself, have been exaggerated.”

Dong said there may be even more to the Framingham Study. Evidence now shows that psychosocial factors, including having a stressed-wired personality, or Type A personality, are more predictive for heart disease than smoking. Even more predictive of CHD is how the Type A personality copes with stress. If Type A’s constantly cope with stress in angry, aggressive, and hostile ways, their odds for getting CHD increase exponentially.

Do You Have Traits of a Type A personality?

Do you feel guilty if you use free time to relax? Do you need to win in order to enjoy games and sports? Do you eat, walk, and move rapidly? Do you try to do more than one thing at a time? Have your loved ones and co-workers told you more than a few times that you need to calm down, mellow out, or take it easy?

You may be a “Type A” personality, or have a Type A behavior pattern (TABP). As much as you get things done and people can count on you to work hard, your health might suffer if you take your high achievement, competitiveness, and impatience too far. Some people can take on multiple projects and carry the weight of the world with grace, but most Type A’s do not.

Whichever questionnaire or survey you take to determine your personality type, your most prominent type is based on a model. Many of us have taken the Myers-Briggs personality test and learned we may be one of 16 personality types composed of four major components. Yet, wait a minute. In most situations, we are a combination of personality archetypes, shifting with age and circumstance. Sometimes we are both Carrie and Miranda. Sometimes we are a little Charlotte.

Since the first years of civilization, philosophers, psychologists, and social scientists have been trying to understand the human psyche and organize people into neat, little piles. The idea is that if we can figure out what makes them act the way they do, we can create a treatment to help them achieve a happy, healthy life.

The first known physicians to make the connection between personalities and illness were the Roman revivalists who warned us of the downside of choleric, sanguine, phlegmatic, and melancholy personality types known at the “Four Temperaments of Personality.”

These four qualities based on Greek theory and elements of earth, air, fire, and water are still used in modern theory to describe disease tendencies. As you may have guessed, the fiery, energetic, and passionate “choleric” personalities are known as today’s Type A’s—with the unfortunate designation: Most likely to develop heart disease.

But descriptions have become more nuanced as the social sciences have developed. A 2018 study from Northwestern University has determined four redefined personality types: “average,” “reserved,” “self-centered,” and “role-model.” From the sound of those names, the Type A could be hiding in any one of the new personality types.

Northwestern’s revamped types are based on five widely-accepted character traits, including neuroticism—a way of being that typically involves negative emotions such as anger. This is the piece of the puzzle cardiologists pay attention to as their predecessors have warned us that how one deals with diversity determines heart health.

What Puts Type A Personalities Further at Risk for Heart Disease?

For more than 100 years, clinical observation of CHD patients has linked this disease with certain personality traits of Type As: impatience, hyper-alertness, aggressiveness, and proneness to anger.

Two American cardiologists, Meyer Friedman and Ray Rosenman, began revisiting the link between behavior patterns and heart disease in the 1950s, pioneering the definition of the Type A personality and its link to heart disease.

The impetus of their work is quite a story. According to a fascinating piece in Scientific American, the cardiologists came upon the heart/stress connection by accident, when their office room upholsterer realized their patients were wearing out the waiting room chairs.

Looking further into the situation, the doctors realized their cardiac patients were impatient with waiting. Because they were Type As, they were unable to sit in their chairs like patient and relaxed Type Bs, and even wore out the arms of the chairs by sitting on the edge of their seats and leaping up too often.

So the two cardiologists began studying their hypothesis that Type A personalities not only wear out chairs, but also wear out their hearts.

In 1976, the cardiologists performed the Western Collaborative Group Study, a longitudinal study of stressed-out behavior and came up with the “Type A” personality definition. They officially characterized the Type A personality as individuals who are highly competitive, ambitious, work-driven, time-conscious, and aggressive. Studies conducted over the next 50 years have found Type A personalities run a higher risk of heart disease and high blood pressure than mellow Type Bs.

Studies carried out on women have not shown such a substantial difference between Type A and Type B and subsequent health, some psychologists say, which may suggest that different stress coping strategies are just as important as personality.

Friedman and Rosenman found evidence  in the early 80s that white, middle-class men with Type A personality are most at risk for CHD.

“It wasn’t till the 1980s that there was enough data for people to say type A is for real,” said Robert Sapolsky, a neurobiologist and primatologist at Stanford University, in an interview with Scientific American. “It is a bigger risk factor for cardiovascular disease than if you smoke, than if you are overweight, than if you have elevated cholesterol levels.”

The Framingham studies supported Friedman and Rosenman’s theories on the key risk group. One study found that specific Type A behaviors such as work overload, suppressed hostility, and frequent job promotions put these men at increased risk of developing CHD, especially in the 55–64 year-old age group.

Among men aged 45–64 years, Type A behavior was associated with a twofold risk of severe chest pain, myocardial infarction, and CHD in general, compared to Type B behavior.

Interestingly, the association was found only among white-collar workers and was also independent of the standard coronary risk factors and other psychosocial scales. This prospective study suggests that Type A behavior and suppressed hostility may be involved in the pathogenesis of CHD in both men and women.

In a multivariate analysis, Type A behavior and suppressing anger were independent predictors of CHD incidence. The Framingham Study found a correlation between Type A women (aged 45–64 years) who developed CHD, and men.

The women were surveyed as having the same coping mechanism of dealing with stressful situations by suppressing hostile emotions. Thousands of Type A respondents said in a survey that they would suppress their feelings of tension and anxiety and would not show or discuss anger.

The study concluded that Type A women developed twice as much CHD and three times as much severe chest pain as Type B women.

What Is Happening in the Body When Hostility and Anger Manifest Illness?

According to the National Institutes of Health, anger can lead to excess catecholamine release and subsequent increased cardiovascular reactivity leading to acute sinus tachycardia, hypertension, decreased coronary perfusion, and cardiac instability.

When a person is in a mental state of anger or hostility or “fighting” mode, their sympathetic nerves are often in a state of excitement which results in a faster heart rate, increased myocardial oxygen consumption, increased cardiac output, higher blood pressure, and higher blood glucose. The liver tends to synthesize triglycerides to supply more energy, which in turn contributes to lipid disorders.

We see how anger and hostility manifest in the body, but now we also have scientific evidence that our cells remember each offense. Studies of the heart have shown it to be the greatest organ for cellular memory.

For instance, cellular memory has been demonstrated in the accounts of heart transplant recipients who retain donor personality traits. Evidence has shown that personality preferences can be transferred to another person with the transplanted organ. Through the work of cell memory study, we learn memory is retained beyond the brain and nerve cells.

Current theories describe six possible mechanisms by which memories can be stored: epigenetic, DNA, RNA, protein, energetic, and what some doctors call the “heart brain.” The heart holds onto emotions, whether negative or positive.

“When we respond to stimuli in a negative way, our personal reactions are stored in our bodies, cells, and organs,'' Dong said. “When a similar situation happens again, our cells will respond in a similar way. Repeating such reaction modes over and over will form long-term memories in our cells and body. This means having a negative personality can actually harm our health.”

“The mechanisms of cellular memory are one of the most fascinating fields in science,” she continued, “and there’s so much more to explore. But if we want to eradicate the root cause of diseases like CHD, essentially, we have to treat the ‘illed’ personality, which is really, the materialized spirit.”

How to Treat the Harmful Side of Type A Personality Patterns

A 1991 paper published in the European Journal of Personality by Hans Eysenck, Ph.D., of the University of London examined the Type A personality type risk further.

Eysenck’s analysis of the data indicating anger, aggression, and hostility connecting to CHD physical risk factors made him hopeful for psychological intervention.

He wrote, “No doubt the process is very complex, and may involve many bodily-disease mechanisms. No more is claimed than a beginning to a lengthy, but exciting and worthwhile process of discovery.

In one of Eysenck’s early books, he quotes the sacred texts in the Mahabharata that describe the concept of mind/body illness:

“There are two classes of disease—bodily and mental. Each arises from the other. Neither is perceived to exist without the other. Mental disorders arise from physical ones, and likewise physical disorders arise from mental ones.”

“We now have countless scientific studies in psychology, neurology, and endocrinology that link ‘mind’ and ‘body,’” said Dong. “We are connected with each other, and in fact, interacting with each other on multiple levels.” She added, “One of my previous pharma colleagues, who is a senior microbiologist, shared with me his notion that the human mind and body are one and the same. He told me he recovered from his pain in his leg by using only psychological therapy. In other words, he cured his body by treating his mind. When you treat the mind, you treat the body at the same time.”

Most people know there are proven methods to treat prolonged stress. To find the right method, think about what calms you down. If you don’t like yoga or meditation, there is fishing or reading. There’s something to calm almost any Type A from any cultural background or with any individual interest. The question is, will they see the importance of change to save their lives?

Many Type A people feel they can’t help their hard-wired personalities even though medical and psychological studies show they can develop coping strategies and anger management skills.

“There are pharmaceutical drugs that can help with high blood pressure, and supplements and lifestyle adjustments that can help, but also changing the way you react to situations seems to be essential,” said Dong. “You can go to therapy to learn healthy coping mechanisms to deal with stressful situations, but there are also quite a few things you can do on your own.”

Dong listed three studied ways to help reduce stress for Type A’s who have crossed the line into angry and hostile behaviors.

1) Be more appreciative.

“If we change our views of others, we can be less competitive, but more grateful,” she said.

“Gratitude is good medicine,” said Robert Emmons, Ph.D., a professor of psychology at the University of California Davis and author of The Little Book of Gratitude in an article on heart.org. “Clinical trials indicate that the practice of gratitude can have dramatic and lasting effects on a person’s life. It can lower blood pressure and improve immune function.”

2) Change your environment.

Dong said, “Type As are all about being in control. Try being passive for a day. If you are triggered to anger, move your focus away from the negative emotion by taking a walk in a beautiful place. Listen to traditional music.”

According to a recent Simply Psychology article by Saul McLeod, Ph.D., dealing with stress may not be Type As’ forte because they seem to be in a constant struggle against the clock.

McLeod wrote, “Often, they quickly become impatient with delays and unproductive time, schedule commitments too tightly, and try to do more than one thing at a time, such as reading while eating or watching television.”

Among several techniques the American Psychological Association (APA) suggests in an article titled “How to control anger before it controls you,” one of the key strategies people can teach themselves is to change their environment when they’re angry by giving themselves a break, including scheduling some “personal time” for times of the day that can be particularly stressful. Change your environment. Take breaks.

“Sometimes it’s our immediate surroundings that give us cause for irritation and fury,” the APA wrote. “Problems and responsibilities can weigh on you and make you feel angry at the ‘trap’ you seem to have fallen into and all the people and things that form that trap.”

3) Participate in mindfulness meditation.

In a review published in Springer Science, researchers examined studies on the effects of mindfulness meditation. They found when people participated in meditation and relaxation techniques, they began to react and cope with stress much better and reported increased mindfulness and psychological well-being.

Dong said most people already know that meditation helps with stress and anger, but few people use it to prevent heart disease. “They can learn to handle stressful situations,” she said. “When you distance yourself from your negative emotions, you can return to a balanced emotional state more quickly than letting anger and hostility take control of you. And I truly believe your heart will thank you for it.”

Can people change those parts of themselves that harass them, that may wreak havoc on their hearts? The latest science says, “yes.”

In the words of the Roman philosopher Lucius Seneca: “If you really want to escape the things that harass you, what you’re needing is not to be in a different place, but to be a different person.”

Perhaps your heart is worth it.

◇ References:

Heart Disease Facts | cdc.gov

Cardiovascular diseases

https://academic.oup.com/aje/article-abstract/111/1/37/109962

Framingham Heart Study (FHS) | NHLBI, NIH

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The four temperaments of personality — Teletype

Are you average, reserved, self-centered or a role model? - Northwestern Now

Type A Behavior Pattern and Coronary Heart Disease: Philip Morris’s “Crown Jewel” - PMC

The Stressful Discovery of Type A Personality - Scientific American

Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study

Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study

Type A Behavior Pattern and Coronary Heart Disease: Philip Morris’s “Crown Jewel” - PMC

https://www.scientificamerican.com/article/the-stressful-discovery-of-type-a-personality/

https://academic.oup.com/aje/article-abstract/111/1/37/109962

Role of personality in cardiovascular diseases: An issue that needs to be focused too! - PMC

Organ Transplant Recipients Retain Donor Traits—Why?

https://sci-hub.se/https://doi.org/10.1002/per.2410050203

https://cloudflare-ipfs.com/ipfs/bafykbzaceb5ypanhahlx5ul5sntyvlionnxqcjufn4scuxc4u4rfaqznvqcfy?filename=H.%20J.%20Eysenck%20Ph.D.%20%28auth.%29%20-%20Smoking%2C%20Personality%2C%20and%20Stress_%20Psychosocial%20Factors%20in%20the%20Prevention%20of%20Cancer%20and%20Coronary%20Heart%20Disease-Springer-Verlag%20New%20York%20%281991%29.pdf

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How to control anger before it controls you

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CORRECTION: A previous version of this article incorrectly stated the 1 in 5 deaths statistic in the first paragraph. The Epoch Times regrets the error.