Women take un-Type A behavior to heart.

In affairs of the heart, women often differ from men. A new study indicates that personality traits linked to an early death from heart disease may also vary between the sexes.

Research conducted over the past 30 years finds that male heart-attack survivors stand a greater chance of dying from a heart ailment if they display a Type A personality, one bursting with hostility, cynicism, and impatience (SN: 1/23/88, p.53). The converse appears true for women. Female heart-attack survivors who keep a lid on their anger and react slowly to external events prove most likely to suffer fatal heart problems, report Lynda H. Powell, a psychologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago, and her colleagues.

Their investigation, a rare effort to identify psychological and social factors that put women at risk for suffering recurrences of physical disease, appears in the September/October PSYCHOSOMATIC MEDICINE.

"[This study] challenges our current models of psychosocial factors of heart disease that focus on hostility," writes Margaret A. Chesney, a psychologist at the University of California, San Francisco, in an accompanying comment.

Many researchers assume that findings derived from studies of emotions and heart disease among men apply to women as well, Chesney asserts.

Powell and her colleagues studied 83 women enrolled in clinical trials to determine whether altering Type A behavior diminishes heart problems among heart-attack survivors. Participants entered the project in 1978 and ranged in age from 30 to 63. None smoked cigarettes or suffered from diabetes. At least six months had passed since their first heart attack.

In the following eight to 10 years, six women died of heart attacks or coronary complications.

Women with heart disease and un-Type A traits whose aspirations to a traditional, stable family life go unfulfilled appear to face the bleakest survival prospects, according to Powell's group. Participants in their study maried and had children in the 1940s and 1950s and apparently did not expect to need extensive education for paid employment. When forced to work outside the home following divorce, death of a husband, or reduction in a spouse's income, they could obtain only low-paying jobs. In the study, women who died of heart disease were more often divorced, worked full-time, lacked a college education, and earned no more than $20,000 per year.

Overall, financial and emotional stress appeared to surge in the absence of an intimate relationship. In these cases, women often tried to suppress their anger, resentment, loneliness, and dissatisfaction, the researchers say.

"For women with coronary disease, this combination of factors may be lethal," Powell and her co-workers contend.

The findings require confirmation in a larger sample, the investigators caution. But a strong link between specific psychosocial measures and the risk of death in a group this size suggests that the same pattern will emerge in further studies, they argue.

Most strikingly, women who died of heart disease displayed an absence of any urgency to finish tasks and expressed no anger or agitation during a stressful interview, Powell's group notes. This antithesis of Type A responses may indicate a tendency to suppress unpleasant emotions, they suggest.

In related evidence, women in the Framingham Heart Study who reported suppressing their anger experienced the highest rate of first heart attacks. This was especially true for those in clerical jobs.

Primate research suggests that social isolation and limited freedom of movement boost heart disease among females, Chesney notes. Female monkeys housed alone suffer four times more extensive coronary atherosclerosis than their counterparts housed in social groups, she points out.

Risks uncovered in women and female monkeys may sometimes apply to male heart-attack survivors, Chesney holds. For some, social isolation or job stress may accompany depression, whereas pervasive hostility may lead others to withdraw from social contacts. Powell's study presents a basis for studying these possibilities, she says.