Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence

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Abstract

Purpose of the Review

This review article synthesizes recent research findings on the psychological context of Type D personality and the mechanisms through which Type D affects disease progression and prognosis among patients with coronary heart disease (CHD).

Recent Findings

One in four patients with CHD has a Distressed (Type D) personality, which is characterized by two stable traits: social inhibition and negative affectivity. Type D personality predicts increased mortality and morbidity burden, and poorer health-related quality of life. Type D is part of a family of psychosocial risk factors that affect CHD prognosis. The pattern of co-occurrence of these psychosocial factors and intra-individual differences in psychosocial profiles may affect risk prediction accuracy. Multiple biological and behavioral processes have been associated with Type D personality.

Summary

Identifying pathways explaining the observed associations between Type D personality and CHD is important to improve etiological and pathophysiological knowledge and to design personalized interventions, and targeting specific risk-associated pathways.

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Most cited references 60

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DS14: standard assessment of negative affectivity, social inhibition, and Type D personality.

Johan Denollet (2005)

Type D personality-a joint tendency toward negative affectivity (NA) and social inhibition (SI)-is related to poor cardiac prognosis, but there is no standard for assessing Type D. This study reports on the Type D Scale-14 (DS14) as a standard measure of NA, SI, and Type D. The study included 3813 participants (2508 from the general population, 573 cardiac patients, 732 hypertension patients). They all filled out the DS14, containing 7-item NA and SI subscales; 275 subjects also completed the NEO-FFI, and 121 patients filled out the DS14 twice. Factor analysis of the DS14 yielded 2 dominant traits; all of the NA and SI items loaded between 0.62 to 0.82 on their corresponding factor (N = 3678). The NA scale covered dysphoria, worry, and irritability; the SI scale covered discomfort in social interactions, reticence, and lack of social poise. The NA and SI scales were internally consistent (alpha = 0.88/0.86; N = 3678), stable over a 3-month period (test-retest r = 0.72/0.82) and not dependent on mood and health status (N = 121). NA correlated positively with neuroticism (r = 0.68); SI correlated negatively with extraversion (r = -0.59/-0.65). Scale-level factor analysis confirmed the construct validity of the DS14 against the NEO-FFI. Using a cutoff of 10 (NA > or =10 and SI > or =10), 1027 subjects (28%) were classified as Type D, 21% in the general population versus 28% in coronary heart disease and 53% in hypertension (p < or = .001). Age, sex, and Type D (odds ratio, 3.98; 95% confidence interval, 3.2-4.6; p <.0001) were independently associated with cardiovascular morbidity. The DS14 is a brief, psychometrically sound measure of negative affectivity and social inhibition that could readily be incorporated in epidemiologic and clinical research.

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Decline in Cardiovascular Mortality: Possible Causes and Implications.

George Mensah, Gina Wei, Paul Sorlie … (2017)

If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease and stroke has been the success story of the century's past 4 decades. The early phase of this decline in coronary heart disease and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the US population aged. However, in 1978, the participants in a conference convened by the National Heart, Lung, and Blood Institute concluded that a significant recent downtick in coronary heart disease and stroke mortality rates had definitely occurred, at least in the US Since 1978, a sharp decline in mortality rates from coronary heart disease and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The National Heart, Lung, and Blood Institute, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.

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Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies

Yong Gan, Yanhong Gong, Xinyue Tong … (2014)

Background Several systematic reviews and meta-analyses demonstrated the association between depression and the risk of coronary heart disease (CHD), but the previous reviews had some limitations. Moreover, a number of additional studies have been published since the publication of these reviews. We conducted an updated meta-analysis of prospective studies to assess the association between depression and the risk of CHD. Methods Relevant prospective studies investigating the association between depression and CHD were retrieved from the PubMed, Embase, Web of Science search (up to April 2014) and from reviewing reference lists of obtained articles. Either a random-effects model or fixed-effects model was used to compute the pooled risk estimates when appropriate. Results Thirty prospective cohort studies with 40 independent reports met the inclusion criteria. These groups included 893,850 participants (59,062 CHD cases) during a follow-up duration ranging from 2 to 37 years. The pooled relative risks (RRs) were 1.30 (95% CI, 1.22-1.40) for CHD and 1.30 (95% CI, 1.18-1.44) for myocardial infarction (MI). In the subgroup analysis by follow-up duration, the RR of CHD was 1.36 (95% CI, 1.24-1.49) for less than 15 years follow-up, and 1.09 (95% CI, 0.96-1.23) for equal to or more than 15 years follow-up. Potential publication bias may exist, but correction for this bias using trim-and-fill method did not alter the combined risk estimate substantially. Conclusions The results of our meta-analysis suggest that depression is independently associated with a significantly increased risk of CHD and MI, which may have implications for CHD etiological research and psychological medicine. Electronic supplementary material The online version of this article (doi:10.1186/s12888-014-0371-z) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Nina Kupper: +31 13 466 2956 , h.m.kupper@tilburguniversity.edu

Johan Denollet: j.denollet@tilburguniversity.edu

Journal

Journal ID (nlm-ta): Curr Cardiol Rep

Journal ID (iso-abbrev): Curr Cardiol Rep

Title: Current Cardiology Reports

Publisher: Springer US (New York )

ISSN (Print): 1523-3782

ISSN (Electronic): 1534-3170

Publication date (Electronic): 12 September 2018

Publication date PMC-release: 12 September 2018

Publication date (Print): 2018

Volume: 20

Issue: 11

Electronic Location Identifier: 104

Affiliations

[1 ]ISNI 0000 0001 0943 3265, GRID grid.12295.3d, Center of Research on Psychology in Somatic Diseases, , Tilburg University, ; PO box 90153, 5000 LE Tilburg, The Netherlands

[2 ]ISNI 0000 0001 0943 3265, GRID grid.12295.3d, Department of Medical & Clinical Psychology, , Tilburg University, ; Tilburg, The Netherlands

Article

Publisher ID: 1048

DOI: 10.1007/s11886-018-1048-x

PMC ID: 6153564

PubMed ID: 30209683

SO-VID: 9e85463e-4e79-4805-bd83-105ce2d984cf

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Funding

Funded by: Tilburg University

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: type d personality,coronary heart disease,heterogeneity,risk profiles,atherosclerosis,cardiac mortality,stress,biobehavioral mechanisms

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: type d personality, coronary heart disease, heterogeneity, risk profiles, atherosclerosis, cardiac mortality, stress, biobehavioral mechanisms

Type D Personality as a Risk Factor in Coronary Heart Disease: a Review of Current Evidence

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Abstract

Purpose of the Review

Recent Findings

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Karger: Cardiovascular System

Most cited references 60

DS14: standard assessment of negative affectivity, social inhibition, and Type D personality.

Decline in Cardiovascular Mortality: Possible Causes and Implications.

Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies

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