SECOND OPINION:Those with high levels of hostility more prone to a stroke, writes JACKY JONES
WHEN I began working in health education in the 1970s I spent at least two evenings a week meeting community groups in dingy venues. The education topic was often heart disease and stroke, which were massive problems.
The risk factors for these health conditions haven’t changed over they years: smoking, high blood pressure, high cholesterol and stress. At that time psychologists had identified Type A and Type B personalities, where Type A people are hostile, competitive, impatient and irritable, and Type B more relaxed and co-operative.
In 1978, Type A behaviours were linked to coronary heart disease (CHD) by the Framingham Heart Study: a major American project. Researchers found a link between Type A personality traits, such as angry behaviour and hostility, and the prevalence of CHD in men and women. Marital dissatisfaction and conflict were also linked to CHD. Many other studies have shown that the Framingham-Type-A-Scale is a valid predictor of heart disease and that hostility and angry behaviour are the most damaging components.
The latest research, published last month in The Journal of Neurology, Neurosurgery and Psychiatry, found that stressful habits and Type A behaviours are associated with a high risk of stroke in men and women.
The stress scale used in the study included items such as: losing your job (47 points), changes in financial state (38 points), large mortgage (31 points), and so on. The Type A scale asked participants to rate themselves in relation to behaviours such as being in a hurry, preoccupation with work and difficulties in talking about feelings.
Participants who lived under stressful conditions in the previous year were nearly four times more likely, and those with high levels of hostility and aggression more than twice as likely, to suffer a stroke compared with the control group. The researchers recommend that the influence of psychosocial factors, including anger management, should be an additional therapy to prevent stroke and heart problems.
Stress as a risk factor, and in particular angry behaviour and hostility, is mostly ignored in Irish prevention and treatment programmes. Recent reports from the Institute of Public Health (IPH) on heart disease and high blood pressure don’t include stress as a risk factor.
Changing Cardiovascular Health: National Cardiovascular Health Policy 2010-2019, from the Department of Health and Children, has eight words on stress and does not include anger and hostility as behavioural risk factors. HSE heart health programmes don’t mention aggression or hostility as behaviours that need to be focused on as intensively as smoking, physical activity and healthy eating. Why is this?
One reason is Irish CHD prevention and treatment programmes are almost exclusively designed from the perspective of physical health and medical treatments, with little or no social, psychological or emotional components: they are not holistic. Those designing such programmes do not believe in aspects of health that can’t be measured in “real” numbers.
Doses of Aspirin, statins, blood pressure and cholesterol levels can be objectively measured, whereas stress and other psychometric scales are seen as subjective measures because people rate themselves. In fact, psychometric scales are as reliable as laboratory tests and there is no reason to exclude stress and hostility as valid risk factors for heart disease.
Many countries include psychosocial risk factors in their CHD prevention programmes and patients receive help with anger and hostility management in addition to the usual advice about smoking and exercise. These programmes deliver big reductions in hostile behaviours and a 44 per cent reduction in the recurrence of heart problems.
Deaths from CHD have been declining in Ireland since the late 1980s because of public health measures, such as banning smoking in public places, and more effective drug and surgical treatments. Between 1994 and 2003, deaths from CHD have declined by 25 per cent in men and 23 per cent in women.
Unfortunately, increases in the numbers of people with obesity and diabetes, and decreases in physical activity levels are reversing these positive trends. The IPH estimates the number of adults with CHD will increase by 23 per cent by 2020. Every intervention that can be used must be used, including anger and hostility management programmes.
Dr Jacky Jones is a former HSE regional manager of health promotion.