Usefulness of Type D Personality in Predicting Five-Year Cardiac Events Above and Beyond Concurrent Symptoms of Stress in Patients With Coronary Heart Disease
Open accessAbstract
Psychological stress and type D personality have been associated with adverse cardiac prognosis, but little is known about their relative effect on the pathogenesis of coronary heart disease (CHD). "Type D" refers to the tendency to experience negative emotions and to inhibit the expression of these emotions in social interactions. We investigated the relative effect of stress and type D personality on prognosis at 5-year follow-up. At baseline, 337 patients with CHD who participated in cardiac rehabilitation filled in the General Health Questionnaire (psychological stress) and the Type D personality scale. Patients were followed for 5 years. The end point was major adverse cardiac events, which were defined as a composite of cardiac death, myocardial infarction, and cardiac revascularization (coronary artery bypass grafting/percutaneous coronary intervention). There were 46 major adverse cardiac events at follow-up, including 4 deaths and 8 myocardial infarctions. Type D patients had an increased risk of death/infarction (odds ratio 4.84, 95% confidence interval 1.42 to 16.52, p = 0.01) compared with non-type D patients, independent of disease severity. Stress (p = 0.011) and type D (p = 0.001) were related to an increased risk of developing a major adverse cardiac event after adjusting for gender, age, and biomedical risk factors. Multivariate analysis yielded left ventricular ejection fraction < or =40%, no treatment with coronary artery bypass grafting, and type D personality (odds ratio 2.90, 95% confidence interval 1.42 to 5.92, p = 0.003) as independent predictors of major adverse cardiac events, whereas psychological stress was marginally significant (odds ratio 2.01, 95% confidence interval 0.99 to 4.11, p = 0.054). In conclusion, type D personality is a psychological factor that may optimize risk stratification in patients with CHD. Type D reflects more than temporary changes in general stress level because it predicted cardiac events after controlling for concurrent symptoms of stress.
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Specific emotional experiences have distinct neurobiological and behavioral features and uniquely contribute to CVD risk.
“However, specific emotional experiences have distinct neurobiological and behavioral features, and they uniquely contribute to CVD risk. 10-13”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [12]
The Results (p. 4) show that type D personality predicted five-year cardiac events in patients with coronary heart disease independently of concurrent stress symptoms. The discussion (p. 5) says its biological and behavioral characteristics that might promote disease progression still need to be determined. The paper therefore does not establish that specific emotional experiences have distinct neurobiological and behavioral features or that each uniquely contributes to CVD risk. (LLM, conf=0.86)
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- Authors
- Denollet, J., Pedersen, S. S., Vrints, C. J., & Conraads, V. M.
- Affiliations
- Tilburg University (NL)
- Antwerp University Hospital (BE)
- Corresponding author
- Denollet, Johan
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2006-04
- Volume
- 97
- Issue
- 7
- Pages
- 970-973
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2094103850
- Cited by
- 236
- References
- 4
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 7 · 2022: 2 · 2021: 13 · 2020: 5 · 2019: 7 · 2018: 9 · 2017: 10 · 2016: 15 · 2015: 9 · 2014: 13 · 2013: 20 · 2012: 26
- FWCI
- 12.42
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research portal (Tilburg University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- Type D personality, psychological stress, coronary artery disease, major adverse cardiac events, cardiac prognosis, risk stratification, myocardial infarction, cardiovascular mortality, left ventricular ejection fraction, coronary artery bypass grafting, percutaneous coronary intervention, cardiac rehabilitation, negative affectivity
- MeSH terms
- Adult, Aged, Coronary Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Personality, Predictive Value of Tests, Risk Factors, Stress, Psychological, Treatment Outcome
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