Personality Traits in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries

Published:November 30, 2018DOI:



      The purpose of this study was to describe type A behavior pattern and trait anger in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and compare them with patients with coronary heart disease and healthy controls. Type A behavior pattern and anger have been linked to coronary heart disease in previous studies. This is the first study to assess type A behavior pattern and trait anger in MINOCA patients.


      One hundred MINOCA patients, consecutively recruited during 2007-2011 at 5 coronary care units in Stockholm, were matched for sex and age to 100 coronary heart disease patients and 100 healthy controls. All participants completed the Bortner Rating Scale to quantify type A behavior pattern and the Spielberger Trait Anger Scale to quantify anger 3 months after the acute event.


      MINOCA patients’ Bortner Rating Scale score was 70.9 ± 10.8 (mean ± SD) and Spielberger Trait Anger Scale score was 14 (12-17) (median; interquartile range). Coronary heart disease patients’ Bortner Rating Scale score was 70.5 ± 10.2 and Spielberger Trait Anger Scale score was 14 (12-17). Healthy controls’ Bortner Rating Scale score was 71.9 ± 9.1 and Spielberger Trait Anger Scale score was 13 (11-16).


      We found no significant differences in Bortner Rating Scale score and Spielberger Trait Anger Scale score among MINOCA, coronary heart disease patients, and healthy controls, regardless of whether total scores, subscales, or cutoffs were used to classify type A behavior pattern and trait anger. However, we cannot exclude the existence of an occasional episode of anger or mental stress in relation to the coronary event. This is the first study to assess type A behavior pattern and trait anger in patients with MINOCA, and future studies need to confirm the current findings before any firm conclusions can be made.


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        • Pasupathy S
        • Air T
        • Dreyer RP
        • Tavella R
        • Beltrame JF
        Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.
        Circulation. 2015; 131: 861-870
        • Agewall S
        • Daniel M
        • Eurenius L
        • et al.
        Risk factors for myocardial infarction with normal coronary arteries and myocarditis compared with myocardial infarction with coronary artery stenosis.
        Angiology. 2012; 63: 500-503
        • Larsen AI
        • Galbraith PD
        • Ghali WA
        • Norris CM
        • Graham MM
        • Knudtson ML
        Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries.
        Am J Cardiol. 2005; 95: 261-326
        • Daniel M
        • Ekenbäck C
        • Agewall S
        • et al.
        Risk factors and markers for acute myocardial infarction with angiographically normal coronary arteries.
        Am J Cardiol. 2015; 116: 838-844
        • Daniel M
        • Agewall S
        • Caidahl K
        • et al.
        Effect of myocardial infarction with nonobstructive coronary arteries on physical capacity and quality-of-life.
        Am J Cardiol. 2017; 120: 341-346
        • Yusuf S
        • Hawken S
        • Ounpuu S
        • et al.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
        Lancet. 2004; 364: 937-952
        • Friedman M
        • Rosenman RH
        Association of specific overt behavior pattern with blood and cardiovascular findings.
        J Am Med Assoc. 1959; 169: 1286-1296
        • Williams JE
        • Nieto FJ
        • Sanford CP
        • Tyroler HA
        Effects of an angry temperament on coronary heart disease risk: the Atherosclerosis Risk in Communities study.
        Am J Epidemiol. 2001; 154: 230-235
        • Chida Y
        • Steptoe A
        The association of anger and hostility with future coronary heart disease. A meta-analytic review of prospective evidence.
        J Am Coll Cardiol. 2009; 53: 936-946
        • Buckley T
        • Soo Hoo SY
        • Fethney J
        • Shaw E
        • Hanson PS
        • Tofler GH
        Triggering of acute coronary occlusion by episodes of anger.
        Eur Heart J Acute Cardiovasc Care. 2015; 4: 493-498
        • Mittleman MA
        • Maclure M
        • Sherwood JB
        • et al.
        Triggering of acute myocardial infarction onset by episodes of anger.
        Circulation. 1995; 92: 1720-1725
        • Bortner RW
        A short rating scale as a potential measure of pattern A behavior.
        J Chronic Dis. 1969; 22: 87-91
        • Catipovic-Veselica K
        • Glavas B
        • Kristek J
        • Sram M
        Components of type A behavior and two-year prognosis of patients with acute coronary syndrome.
        Psychol Rep. 2001; 89: 467-475
        • Edwards JR
        • Baglioni Jr, AJ
        The psychometric properties of the Bortner type A scale.
        Br J Psychol. 1990; 81: 315-333
        • Forgays DG
        • Forgays DK
        • Spielberger CD
        Factor structure of the State-Trait Anger Expression Inventory.
        J Pers Assess. 1997; 69: 497-507
        • Williams JE
        • Paton CC
        • Siegler IC
        • Eigenbrodt ML
        • Nieto FJ
        • Tyroler HA
        Anger proneness predicts coronary heart disease risk: prospective analysis from the Atherosclerosis Risk in Communities (ARIC) study.
        Circulation. 2000; 101: 2034-2039
        • Belgian- French Pooling Project T
        Assessment of type A behaviour by the Bortner scale and ischaemic heart disease. The Belgian-French pooling project.
        Eur Heart J. 1984; 5: 440-446
        • Milicic D
        • Brajkovic L
        • Ljubas Macek J
        • et al.
        Type A personality, stress, anxiety and health locus of control in patients with acute myocardial infarction.
        Psychiatr Danub. 2016; 28: 409-414
        • Lohse T
        • Rohrmann S
        • Richard A
        • Bopp M
        • Faeh D
        Type A personality and mortality: competitiveness but not speed is associated with increased risk.
        Atherosclerosis. 2017; 262: 19-24
        • Bass C
        Type A behaviour in patients with chest pain: test-retest reliability and psychometric correlates of Bortner scale.
        J Psychosom Res. 1984; 28: 289-300
        • Haukkala A
        • Konttinen H
        • Laatikainen T
        • Kawachi I
        • Uutela A
        Hostility, anger control, and anger expression as predictors of cardiovascular disease.
        Psychosom Med. 2010; 72: 556-562
        • Moss-Morris R
        • Weinman J
        • Petrie KJ
        • Horne R
        • Cameron LD
        • Buick D
        The revised Illness Perception Questionnaire (IPQ-R).
        Psychol Health. 2002; 17: 1-16
        • Grace SL
        • Krepostman S
        • Brooks D
        • et al.
        Illness perceptions among cardiac patients: relation to depressive symptomatology and sex.
        J Psychopathol Behav Assess. 2005; 59: 153-160
        • Sarkar U
        • Ali S
        • Whooley MA
        Self-efficacy and health status in patients with coronary heart disease: findings from the heart and soul study.
        Psychosom Med. 2007; 69: 306-312
        • Compare A
        • Bigi R
        • Orrego PS
        • Proietti R
        • Grossi E
        • Steptoe A
        Type D personality is associated with the development of stress cardiomyopathy following emotional triggers.
        Ann Behav Med. 2013; 45: 299-307
        • Salmoirago-Blotcher E
        • Rosman L
        • Wittstein IS
        • et al.
        Psychiatric history, post-discharge distress, and personality characteristics among incident female cases of takotsubo cardiomyopathy: a case-control study.
        Heart Lung. 2016; 45: 503-509
        • Manrique-Garcia E
        • Sidorchuk A
        • Hallqvist J
        • Moradi T
        Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis.
        J Epidemiol Community Health. 2011; 65: 301-309
        • Raju G
        • Krishnaswamy S
        • Verghese A
        Usefulness of Bortner rating scale in the measurement of type A behaviour pattern.
        Indian J Psychiatry. 1987; 29: 373-376
        • Edwards JR
        • Baglioni AJ
        Relationship between type A behavior pattern and mental and physical symptoms: a comparison of global and component measures.
        J Appl Psychol. 1991; 76: 276-290
        • Myrtek M
        Meta-analyses of prospective studies on coronary heart disease, type A personality, and hostility.
        Int J Cardiol. 2001; 79: 245-251