I had the good fortune of beginning graduate school when my major professor, David Glass, began his theoretical work on the Type A behavior pattern as a coping style aimed at maintaining control over stressful circumstances. Two cardiologists, Meyer Friedman and Ray Rosenman, described the Type A pattern as a constellation of characteristics: competitiveness, excessive achievement striving, time urgency, hypervigilance, and easily angered and hostile. They demonstrated that initially healthy men classified as Type A were at higher risk for subsequent coronary heart disease (CHD) compared to non-Type As (called Type Bs). As one who had vacillated between becoming a physician versus becoming a psychologist, I thought that investigating Type A behavior would be an optimal way to combine my interests in both psychology and health. Little did I realize at the time that a focus on Type A would launch my own career in investigating more broadly the psychological underpinnings of risk for cardiovascular disease (CVD). My primary research questions were two-fold: Who is at psychological risk for CVD? How does psychological risk for CVD develop over the life span? Before I describe how we addressed those questions, I briefly describe cardiovascular diseases, and I conclude by describing next steps for these research questions.

Cardiovascular Disease

Cardiovascular disease (CVD) refers to a number of diseases of the heart and circulation. Underlying many types of CVD is atherosclerosis, the accumulation of plaque in the arterial wall. Plaque is composed of fat, cholesterol, and other substances. Over time, the build-up of plaque and potential for rupture can partially or completely block blood flow to tissues, resulting in ischemia (i.e., inadequate blood supply) and tissue death. Depending on which arteries are blocked by plaque, different conditions occur. Heart attacks and chest pain (angina) result from inadequate blood flow to the coronary arteries, stroke from inadequate blood flow to carotid arteries, and peripheral artery disease from inadequate blood flow to the arteries in the legs. Atherosclerosis develops slowly over the life-span, beginning in adolescence and young adulthood and accelerating in women after the menopause and in men in midlife. These facts suggest that investigations of psychological risk for CVD should take a life-span approach.