Letter

Relation between hostility and coronary heart disease

BMJ 1999; 319 doi: 10.1136/bmj.319.7214.917 (Published 2 October 1999)
Cite this as: BMJ 1999;319:917

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Evidence does not support link

  1. Mark Petticrew, associate director,
  2. Simon Gilbody, MRC health services research training fellow,
  3. Trevor A Sheldon, professor
  1. MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ
  2. NHS Centre for Reviews and Dissemination, University of York, York
  3. York Health Policy Group, University of York, York
  4. International Centre for Health and Society, Royal Free and University College London Medical School, London WC1E 6BT

    EDITOR—The summary points of Hemingway and Marmot's review of psychosocial risk factors for coronary heart disease may be misleading.1 The first of these states that “prospective cohort studies show a possible aetiological role for type A/hostility.” However, of the four prospective studies of hostility, only two show any significant association between hostility and coronary heart disease (one for women only). Six of the nine aetiological studies of type A behaviour also show no association with coronary heart disease. The other three studies give no information on completeness of follow up or whether outcomes such as angina were assessed in a blinded manner. One of these studies had minimal adjustment for confounding. No study showed any prognostic role for type A behaviour or hostility. Taken together, these studies do not represent robust evidence that these psychological variables have an important role in the development or prognosis of coronary …

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