Commentary: Masculinity, femininity and heart disease

Women have less and later coronary heart disease (CHD) than men worldwide, unlikely to be explained by men’s more unfavourable lifestyle or the pressures of their more frequent work outside the home, previously popular explanations.1 Differences in male and female personality are another explanation for male–female CHD disparities. In a 1999 systematic review of psychosocial factors in the aetiology of CHD, Hemingway and Marmot1 found type A behaviour/ hostility was the only personality trait that had been studied prospectively in at least two population-based studies with CHD outcomes; a positive association was found in 6 of the 14 studies. The concept of coronary-prone (type A) behaviour was introduced by Friedman and Rosenman,2,3 who reported that a behaviour pattern characterized by aggressiveness, competitive-ness, hostility and time urgency was associated with CHD i