BACKGROUND:

Prevention of coronary heart disease (CHD) will be enhanced by controlling hypertension, reducing blood cholesterol, maintaining normal weight, increasing physical activity, reducing smoking, and having a healthy diet. Understanding how to achieve these important public health aims requires an understanding of the behavioral factors involved in prevention. Behavioral risk factors remain the single most preventable cause of human illness and suffering. The University of North Carolina Alumni Heart Study is ideally suited to explore the associations between and among these important behavioral risk factors, and to understand how personality, in particular individual differences in hostility and depression act to determine individuals' risk factor behaviors, and to answer important questions about the role of hostility and psychosocial factors in CHD risk during the middle years.

The University of North Carolina Alumni Heart Study (UNCAHS) is a prospective study of the role of psychosocial factors, in particular hostility, in the development of coronary heart disease. The target population is composed of persons who completed the Minnesota Multiphasic Personality Inventory while attending the University of North Carolina in the mid-1960s.

DESIGN NARRATIVE:

Surveillance of the members of the UNC Alumni Heart Study continues for an additional five-year period . Studies continue on how hostility and other psychosocial factors are related to each other and how they contribute to coronary heart disease risk. Data are analyzed in order to test hypotheses about the role of psychosocial factors in weight parameters, dietary practices and the contribution of spouse hostility to coronary risk.

To better understand the dynamic interrelationships of psychosocial and behavioral risk factors of the adult life span, the trajectories of hostility, depression, smoking, body mass, exercise patterns, and alcohol consumption will be mapped using multiple assessments from age 19 to age 60. It is predicted that a significant proportion of the change in risk behavior will be due to trajectories of hostility and depression, operating singly and in combination over time. Tests will be made of the prospective associations of hostility, depression, and other psychosocial variables (e.g., social support and job strain) with coronary events and mortality observed while the cohort is middle-aged. The scope of the psychosocial variables will be broadened to examine individual differences in personality over the life course and dietary practices at midlife in addition to the indicators noted above. The effect of gender on the natural history of coronary disease and coronary risk profiles in women will be examined by monitoring changes in menopausal status, and patterns of hormone replacement therapy use among women during midlife and the associations of these factors with the other risk indicators.