Type D personality associated with higher future heart risk

September 14, 2010, American Heart Association

Heart patients with the "distressed" (Type D) personality profile may face a higher risk of future cardiovascular problems, according to a summary article published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

An analysis of previous reports involving more than 6,000 patients found an association between the Type D and future cardiovascular issues among heart patients.

The personality classification system that identified "Type A" decades ago more recently defined Type D as a personality marked by chronic , pessimism and social inhibition.

Researchers noted a three-fold increase for Type D heart patients in risk of future cardiovascular issues such as , angioplasty or bypass procedures, , , heart attack or death.

"Type D patients tend to experience increased levels of anxiety, irritation and depressed mood across situations and time, while not sharing these emotions with others because of fear of disapproval," said Viola Spek, Ph.D., senior author of the study and a researcher at Tiburg University in the Netherlands. "We found that Type D personality predicts mortality and morbidity in these patients, independent of traditional medical risk factors."

Researchers analyzed 49 studies of Type D personality and future heart health or psychological health. A Type D profile was also linked to a three-fold increase in long-term risk of psychological conditions including clinical depression, anxiety or poor mental health.

Screening heart patients for such personality traits could give doctors the chance to intervene early with psychological or behavioral counseling and perhaps improve cardiovascular outcomes.

"Type D personality and depression are distinct manifestations of psychological distress, with independent cardiovascular effects," said Johan Denollet, Ph.D., lead author of the study. "Our findings support the simultaneous use of depression and Type D measures to flag high-risk patients."

The Type D personality profile is determined using a brief 14-item questionnaire that measures social inhibition and overall mood. Patients responded to phrases such as, "I am a closed kind of person," and "I often feel unhappy."

The alphabetic personality classification scheme dates to the recognition of the Type A behavior pattern decades ago, the scientists noted. Other types followed, and the Type D framework arose in the 1990s. Findings have been mixed regarding whether the Type A profile, probably the best known, is associated with worse cardiovascular outcomes. Traits that define Type A include competitiveness, a focus on achievement, a sense of urgency and hostility.

The Type D profile is relatively new, but the number of studies tracking Type D patients' future health is growing, researchers said. Due to a lack of other data on long-term prognosis, researchers used their own previous studies for the current analysis. Recent studies from other research groups have uncovered biological and behavioral pathways that may explain this adverse effect of Type D.

Type D patients appear to respond differently to cardiovascular stress. Type D is associated with differences in cortisol, a stress hormone that can temporarily increase blood pressure. It also may be related to elevated levels of inflammation. In addition, heart patients with Type D personality may be less likely to get regular medical checkups or communicate effectively with their physicians.

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