title: Type D personality is associated with increased levels of tumour necrosis factor (TNF)-alpha and TNF-alpha receptors in chronic heart failure.
abstract: BACKGROUND
  Pro-inflammatory cytokines and their circulating receptors are powerful predictors of poor outcome in patients with chronic heart failure (CHF). We hypothesized that Type D personality, known to independently predict long-term mortality in patients with coronary heart disease, would relate to immune activation in CHF.
  
  
  METHODS
  91 stable CHF patients (79% males, mean age 57+/-13 yrs, 58% ischemic heart disease) with left ventricular ejection fraction <or=35% completed a psychological questionnaire to assess Type D personality (i.e., the tendency to experience negative emotions and to inhibit their expression). Plasma levels of tumour necrosis factor (TNF)-alpha, soluble TNF-alpha receptor 1 and 2 (sTNFR1 and sTNFR2) and interleukin-6 (IL-6) were measured by ELISA.
  
  
  RESULTS
  Type D patients (n=30) had higher levels of TNF-alpha (5.1+/-2.9 versus 3.9+/-2.6 pg/ml, p=0.066), sTNFR1 (1656+/-1057 versus 1098+/-424 pg/ml, p=0.009) and sTNFR2 (2869+/-1510 versus 2011+/-794 pg/ml, p=0.006) as compared to non-Type D patients (n=61), whereas IL-6 was not different. After controlling for sex, age, ischemic etiology and disease severity, multivariate analysis yielded Type D as the strongest predictor of increased TNF-alpha (OR=2.9, p=0.048) and sTNFR2 levels (OR=3.9, p=0.018). For sTNFR1, the effect of Type D was no longer significant in this analysis (OR=2.7, p=0.112).
  
  
  CONCLUSIONS
  Type D personality was independently associated with increased circulating levels of TNF-alpha and sTNFR2 in patients with CHF. This study provides the strongest evidence to date that chronic emotional distress may be associated with immune activation in heart failure.
authors.affiliation: Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. Viviane.Conraads@uza.be
authors.forename: Viviane M
authors.initials: VM
authors.lastname: Conraads
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Luc S
authors.initials: LS
authors.lastname: De Clerck
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Stevens
authors.forename: Chris
authors.initials: C
authors.lastname: Bridts
authors.forename: Christiaan J
authors.initials: CJ
authors.lastname: Vrints
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000097:blood* / Q000523:psychology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010551:Personality; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood*; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D047888:Receptors, Tumor Necrosis Factor, Type I; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha