title: Cytokines and immune activation in systolic heart failure: the role of Type D personality.
abstract: The proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) and its soluble receptors 1 (sTNFR1) and 2 (sTNFR2) are predictors of mortality in chronic heart failure (CHF) but the determinants of these increased levels of disease-promoting cytokines are largely unknown. Type D personality refers to the combination of the tendency to experience negative emotions (negative affectivity) and the tendency to inhibit the expression of emotions in social interaction (social inhibition). Type D is an independent predictor of cardiac events in coronary patients who are at risk for CHF. The present study examined the effect of Type D personality on TNF-alpha, sTNFR1, and sTNFR2 in 42 men with CHF (meanage=57.9+/-10.5 years). There was a significant multivariate effect of Type D on TNF-alpha measures (p=.006); i.e., circulating levels of TNF-alpha (4.8+/-0.9 versus 2.5+/-0.2 pg/ml, p=.003), sTNFR1 (1814+/-314 versus 1134+/-78 pg/ml, p=.014), and sTNFR2 (2465+/-243 versus 1874+/-118 pg/ml, p=.019) were significantly higher in Type D patients as compared to non-Type D patients. The effect size (ES) of Type D personality ranged from rather large (sTNFR1, ES=0.77; sTNFR2, ES= 0.73) to large (TNF-alpha, ES=0.90). After controlling for ischemic etiology and severity of heart failure, Type D personality emerged as an independent predictor of increased circulating levels of both TNF-alpha (OR=9.5, 95% CI 2.1-43.8, p=.004) and TNF-alpha receptors (OR= 6.1, 95% CI 1.4-25.8, p=.014). These findings are consistent with the prognostic power of Type D personality regarding long-term morbidity and mortality in patients with established coronary heart disease. This study suggests that individual differences in personality contribute to the psychoneuroimmunological aspects of heart failure.
authors.affiliation: Department of Psychology and Health, Tilburg University, Warandelaan, 2, P.O. Box 90153, 5000 LE Tilburg, TheNetherlands. denollet@uvt.nl
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Viviane M
authors.initials: VM
authors.lastname: Conraads
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Brutsaert
authors.forename: Luc S
authors.initials: LS
authors.lastname: De Clerck
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Stevens
authors.forename: Christiaan J
authors.initials: CJ
authors.lastname: Vrints
mesh_terms: D000339:Affect; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000097:blood* / Q000276:immunology* / Q000523:psychology*; D006801:Humans; D007266:Inhibition, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010553:Personality Development; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha