Type D Personality is Unrelated to Major Adverse Cardiovascular Events in Patients with Coronary Artery Disease Treated
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ORIGINAL ARTICLE
Type D Personality is Unrelated to Major Adverse Cardiovascular Events in Patients with Coronary Artery Disease Treated by Intracoronary Stenting Thomas Meyer, Ph.D., M.D. & Sharif Hussein, M.S. & Helmut W. Lange, M.D. & Christoph Herrmann-Lingen, M.D.
# The Society of Behavioral Medicine 2014
Abstract Background Previous research in cardiac patients suggested that type D personality, defined as a combination of negative affectivity (NA) and social inhibition (SI), was associated with adverse outcome. Purpose The objective of this prospective study was to examine the independent prognostic value of type D in patients with coronary artery disease (CAD). Methods A total of 465 patients completed the Type D Scale (DS14) questionnaire before undergoing stent implantation and were followed up for 5 years. Results In a Cox regression model adjusted for selected confounders, we found a trend towards NA for the prediction of nonfatal major adverse cardiovascular event (MACE, hazard ratio (HR)=1.07, 95 % confidence intervals (CIs)=0.99−1.14, p=0.074), while, in contrast, SI was a significant and independent predictor of better outcome (HR=0.92, 95 % CI= 0.86−0.99, p=0.027). Conclusions In a cohort of CAD patients, the type D pattern was not linked to adverse outcome, whereas SI was negatively associated with MACE. Keywords Coronary heart disease . Negative affectivity . Prognosis . Social inhibition . Type D personality T. Meyer : S. Hussein : C. Herrmann-Lingen Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany H. W. Lange Practice for Cardiology, Heart Center Bremen, Bremen, Germany C. Herrmann-Lingen (*) Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre and German Centre for Cardiovascular Research, von-Siebold-Str. 5, 37075 Göttingen, Germany e-mail: [email protected]
Introduction In addition to standard risk factors including depression, acute and chronic emotional distress has been linked to adverse outcomes in patients with coronary artery disease (CAD) [1]. Previous studies identified personality traits such as hostility and anger proneness as major determinants of chronic stress, which conversely appeared to precipitate cardiac events in high-risk individuals [2]. In the mid-1990s, in search of personality traits identifying psychologically vulnerable patients at increased risk of cardiovascular complications, Denollet and colleagues introduced the concept of the “distressed,” or type D, personality which, by definition, referred to a propensity to experience psychological distress characterized by chronic negative emotions and an inhibition of selfexpression in social interactions [3]. Subjects who scored high on this trait tended to feel inhibited and reticent with others and frequently reported adverse feelings, such as dysphoria, anxiety, tension, and irritability [4]. The results of a series of clinical studies, most of which were published by the Dutch-Belgian study group around Denollet, reported on the specifi
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