Adapted from "Beyond Cholestrol" by Elaine Ferguson, M.D., which appeared in Alternative Medicine, Issue #32, November 1999.

Although heart disease, the leading cause of death in the Western world, has been studied for many years, scientists are now finding that beyond the known risk factors--smoking, obesity, high cholesterol levels, hypertension, a sedentary life style, and diabetes--subtler psychosocial factors such as hostility, isolation, and depression, are also responsible for coronary artery disease

For many years, the "Type A" personality--always in a hurry, quick to anger, and highly competitive--was touted as a principal contributor to heart attacks. But as research became more common in this area, studies refined the behavioral profile of potential heart attack victims, and the Type A personality did not consistently predict the development of heart disease.

Redford Williams of Duke University Medical Center found, for example, that a cynical mistrust of others, the overt expression of this cynicism, and hostility expressed in aggressive behavior accounted for higher mortality related to heart disease. "Hostility flares like a beacon, a risk factor that needs to be tempered," Williams wrote in his book, "Anger Kills."

But while it may be critical to one's health to recognize unrelenting anger as a toxic, health-damaging personality trait, it is equally important to know that it can be modified with behavioral therapy and a commitment to change. An international study conducted in Canada, the United States, and Israel, "The Short-Term Effects of Hostility-Reduction Intervention on Male Coronary Heart Disease Patients," which was published in Health Psychology (July 1999), evaluated the effectiveness of an intervention aimed at reducing hostility in patients with coronary artery disease. The project found that heart patients who released at least some of their hostility were able to significantly reduce their blood pressure.

Still the effects of hostility are manifold. One study conducted by the Massachusetts Department of Public Health in 1972, found that, in individuals age 50 and younger, unhappiness was the greatest predictor of heart disease and heart attacks. In his book, Williams connects hostility to unhappiness. He cites a study, "Cynical Hostility at Home and Work: Psychosocial Vulnerability Across Domains," conducted by Timothy Smith, a University of Utah researcher and his colleagues and published in the Journal of Research in Personality (December 1988), which found that college students, who score high on a hostility questionnaire, a part of the Minnesota Multiphasic Personality Inventory (MMPI), a standard psychological test, reported more hassles and negative life events, along with less social support. Williams also points out that hostile people had more marital problems and conflicts in their families. Thus, hostility led to another contributor to heart disease: isolation.

Family Ties

Much has been written about dysfunctional families, but the bonds among family members can also enhance one's health. A most fascinating long-term study was conducted by Stewart Wolf, M.D., in Roseto, Pennsylvania. The researchers sought to explain the very low incidence of heart disease and concluded that the supportive, interactive, and close-knit nature of the town's primarily Italian-American population created their "immunity" to heart disease. A special March 1998 Newsweek issue on health dubbed this phenomenon in Roseto the "Pennsylvania Paradox" because although residents' diets included food generously prepared with lard, they had almost no heart disease. What stood out as a critical variable was the fact that residents held on to the Old World values--drinking wine with meals and maintaining very strong social and familial ties.

Wolf's findings had a counterpart in the French Paradox, a study conducted by Boston University Department of Medicine epidemiologist, Dr. Curtis Ellison, in which the drinking of red wine positive correlated with low heart disease among the French despite a high cholesterol and high fat diet.

Dr. Wolf, who with John G. Bruhn co-authored the 1979 book "The Roseto Story" and the 1993 follow-up book "The Power of Clan," forecasted that when the researchers returned in the mid-1970s they would find increased mortality from heart disease.

When Wolf first arrived in Roseto the town's families lived in tidy homes on a tightly packed avenue, their kitchens were often filled with neighbors who they also met with in the streets after leisurely dinners. Slowly and subtly, however, things changed. Traditionally the men worked in salt quarries, the women in the numerous textile mills, but as education became more important, their children became professionals. The younger people were very respectful of the Roseto spirit and attitudes but didn't want it for themselves. Since maintaining links to the past, which included behaviors that seemed to ward off heart disease, became less important than material success, Dr. Wolf accurately predicted that Roseto would lose its relative immunity to coronary heart.