Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis

Abstract

Objective: Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies (N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease. Method: For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type. Results: In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients. Conclusion: Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.

Type D personality and cardiovascular reactivity to acute psychological stress: A systematic review and meta-analysis.

“…Additionally, five of these studies reported effects of the continuous Type D interaction term while controlling for the main effects of NA and SI (Allen et al, 2019a; Howard et al, 2011; Kelly-Hughes et al, 2014; O’Riordan, Howard, Brown, & Gallagher, 2020; O’Riordan, Howard, & Gallagher, 2022). As well as continuing to confirm effects using this continuous interaction approach, future research could also consider controlling for the quadratic main effects of NA and SI in models when these are shown to be significant (Lodder, 2020b; Lodder et al, 2023).…”

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

“…Psychosocial factors, especially depressive symptoms, but also anxiety, Type D personality, and hostility have consistently been associated with MACE 3,[31][32][33] , which is acknowledged in current guidelines 1,2 . A difference between these studies and the present cohort is that these studies predominantly followed patients with obstructive CAD, who had either acute coronary syndrome, a myocardial infarction, or who received invasive treatment such as PCI or CABG.…”

Clinical and psychological associations and coping strategies for personality type D and depression in patients with coronary artery disease

“…Учитывая значительную и постоянную взаимосвязь дезадаптивных копинг-стратегий у больных ИБС с типом личности Д не только с ментальным компонентом качества жизни и развитием депрессивных симптомов, но и с некоторыми поведенческими привычками (склонность к нездоровой диете), c неуспешными исходами программ кардиологической реабилитации [19] и прогнозом [7], должны быть разработаны поведенческие вмешательства, специально ориентированные на дисфункциональное преодоление трудностей. В этом направлении лечения также видится возможное воздействие на больных ИБС с типом личности Д для нивелирования его известного неблагоприятного влияния на прогноз (что подтверждено в недавно опубликованном метаанализе [20]).…”