title: Personality as independent predictor of long-term mortality in patients with coronary heart disease.
abstract: BACKGROUND
  Emotional distress has been related to mortality in patients with coronary heart disease (CHD), but little is known about the role of personality in long-term prognosis. We postulated that type-D personality (the tendency to suppress emotional distress) was a predictor of long-term mortality in CHD, independently of established biomedical risk factors.
  
  
  METHODS
  We studied 268 men and 35 women with angiographically documented CHD, aged 31-79 years, who were taking part in an outpatient rehabilitation programme. All patients completed personality questionnaire at entry to the programme. We contacted them 6-10 years later (mean 7-9) to find out survival status. The main endpoint was death from all causes.
  
  
  RESULTS
  At follow-up, 38 patients had died; there were 24 cardiac deaths. The rate of death was higher for type-D patients than for those without type-D (23 [27%]/85 vs 15 [7%]/218; p < 0.00001). The association between type-D personality and mortality was still evident more than 5 years after the coronary event and was found in both men and women. Mortality was also associated with impaired left ventricular function, three-vessel disease, low exercise tolerance, and the lack of thrombolytic therapy after myocardial infarction. When we controlled for these biomedical predictors in multiple logistic regression analysis, the impact of type-D remained significant (odds ratio 4.1 [95% CI 1.9-8.8]; p = 0.0004). In this group of CHD patients, type-D was an independent predictor of both cardiac and non-cardiac mortality. Social alienation and depression were also related to mortality, but did not add to the predictive power of type-D.
  
  
  CONCLUSIONS
  We found that type-D personality was a significant predictor of long-term mortality in patients with established CHD, independently of biomedical risk factors. Personality traits should be taken into account in the association between emotional distress and mortality in CHD.
authors.affiliation: University Hospital of Antwerp, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Denollet
authors.forename: S U
authors.initials: SU
authors.lastname: Sys
authors.forename: N
authors.initials: N
authors.lastname: Stroobant
authors.forename: H
authors.initials: H
authors.lastname: Rombouts
authors.forename: T C
authors.initials: TC
authors.lastname: Gillebert
authors.forename: D L
authors.initials: DL
authors.lastname: Brutsaert
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D016022:Case-Control Studies; D016000:Cluster Analysis; D003327:Coronary Disease / Q000401:mortality* / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007266:Inhibition, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010551:Personality / Q000145:classification; D010555:Personality Inventory; D011379:Prognosis; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors