In a randomized, double-blind five-year trial, we tested the efficacy of simultaneously elevating serum levels of high-density lipoprotein (HDL) cholesterol and lowering levels of non-HDL cholesterol with gemfibrozil in reducing the risk of coronary heart disease in 4081 asymptomatic middle-aged men (40 to 55 years of age) with primary dyslipidemia (non-HDL cholesterol greater than or equal to 200 mg per deciliter [5.2 mmol per liter] in two consecutive pretreatment measurements). One group (2051 men) received 600 mg of gemfibrozil twice daily, and the other (2030 men) received placebo. Gemfibrozil caused a marked increase in HDL cholesterol and persistent reductions in serum levels of total, low-density lipoprotein (LDL), and non-HDL cholesterol and triglycerides. There were minimal changes in serum lipid levels in the placebo group. The cumulative rate of cardiac end points at five years was 27.3 per 1,000 in the gemfibrozil group and 41.4 per 1,000 in the placebo group--a reduction of 34.0 percent in the incidence of coronary heart disease (95 percent confidence interval, 8.2 to 52.6; P less than 0.02; two-tailed test). The decline in incidence in the gemfibrozil group became evident in the second year and continued throughout the study. There was no difference between the groups in the total death rate, nor did the treatment influence the cancer rates. The results are in accord with two previous trials with different pharmacologic agents and indicate that modification of lipoprotein levels with gemfibrozil reduces the incidence of coronary heart disease in men with dyslipidemia.

https://www.nejm.org/doi/pdf/10.1056/NEJM198711123172001?listPDF=true

Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease

Despite considerable advances in research and practice over the past three decades, cardiovascular disease and, in particular, coronary heart disease (CHD) remains the primary cause of premature death in the United States. This chapter will illustrate the various methods and concepts within health psychology that have been applied to further our understanding of the factors that contribute to CHD and the various prevention and intervention strategies used to reduce the risk of CHD morbidity and mortality. This chapter will first provide an overview of etiological considerations, including a definition of CHD and specification of risk factors. The remainder of the chapter will focus on “coronary-prone behavior pattern,” or the Type A behavior pattern, as it relates to the development and maintenance of CHD. As was discussed in Chapter 1, this behavior pattern represents the first well-defined psychological or behavioral risk factor in the history of risk factor research in health and illness. Therefore, the Type A behavior pattern will be emphasized, with a focus on (1) defining the pattern and presenting it in historical perspective, (2) describing the pattern and the methods used to measure and identify it, (3) reviewing the research validating the Type A construct and providing an overview of the psychological aspects of the behavior pattern, and (4) reviewing the psychophysiological

Coronary heart disease. Clinical, cinearteriographic and metabolic correlations.

This article explores the implications that dispositional optimism holds for physical well-being. Research is reviewed that links optimism to a number of different positive health-relevant outcomes, ranging from the development of physical symptoms to recovery from coronary artery bypass surgery. Additional findings are described which suggest that these beneficial effects are partly due to differences between optimists and pessimists in the strategies that they use to cope with stress. A number of other potential mediators are also discussed, including some that are physiologic in nature. The article closes with a discussion of the relationships between our own theoretical account of the effects of optimism and several other conceptual approaches.

Dispositional optimism and physical well-being: the influence of generalized outcome expectancies on health

In this article, research on how children and adolescents cope with stress and coping's role in reducing the adverse psychological states associated with stress is reviewed. Child and adolescent coping is reflected in seven different lines of research—infa nts' responses to maternal separation, social support, interpersonal cognitive problem-solving, coping in achievement contexts, Type A behavior pattern in children, repression-sensitization, and resilience to stress. A variety of different coping resources, styles, and specific strategies are important in successfully adapting to stress, including efforts that focus directly on the problem, as well as attempts to deal with adverse emotions associated with stress. Directions for future research are identified, emphasizing the need for more systematic comparisons of coping across different types of stress and over time in response to a single stressful episode. A central feature of human development involves coping with psychosocial stress. Beginning in infancy, individuals are confronted with a stream of potentially threatening and challenging situations that require action and adaptation. The modest to moderate correlations typically found between stressful life events and disorder during childhood and adolescence suggest that individual difference factors related to coping may moderate the stress-disorder relation (see Compas, in press, for a review). The resources available to cope with stress and the manner in which individuals actually cope may be important factors influencing patterns of positive growth and development as opposed to the onset of a host of psychological and somatic problems. Although the study of coping with stress during adulthood has been characterized by increasing convergence in conceptualization and measurement (e.g., Lazarus & Folkman, 1984; Menaghan, 1983; Moos & Billings, 1982), this is not true for coping during childhood and adolescence. Instead, coping in younger age groups has been represented by different definitions and methods of measurement, as well as several divergent lines of research. The purpose of this review is to integrate these somewhat disparate areas of research and to identify future directions for study. First, various definitions and conceptualizations of coping are discussed. Second, empirical studies of coping during childhood and adolescence are reviewed. Finally, conclusions drawn from this research, the major issues facing the field, and directions for future research are outlined.

Coping with stress during childhood and adolescence.

A new meta-analysis of research on hostility and physical health was conducted that includes 15 studies used in previous meta-analytic reviews and 30 new independent studies. Overall, the results suggest that hostility is an independent risk factor for coronary heart disease (CHD). For structured interview indicators of potential for hostility, the weighted mean r was .18. After controlling for other risk factors for CHD, the widely used Cook-Medley Hostility Scale and other cognitive-experiential measures were most predictive of all-cause mortality (weighted mean r = .16) and, to a lesser extent, CHD (weighted mean r = .08). Similar to other areas of research, the increased use of high-risk studies in recent years produced an increase in null findings.

Rayman W. Bortner

Papers

A short rating scale as a potential measure of pattern A behavior.

Competitive drive, pattern a, and coronary heart disease: A further analysis of some data from the Western Collaborative Group Study

Familial similarity in pattern a behavior: Fathers and sons