Type D personality predicts clinical events after myocardial infarction, above and beyond disease severity and depression.
OBJECTIVE
To investigate the effect of Type D personality (high negative affectivity and social inhibition) on cardiac death and/or recurrent myocardial infarction (MI) in patients with acute MI, after adjustment for disease severity and depression. To explore the differential effect of Type D on early (< or = 6 months) versus late (> 6 months) events separately.


METHODS
Patients hospitalized for acute MI (N = 473) were recruited between May 2003 and May 2006. Patients were assessed on demographic and clinical variables and completed the Type D Personality Scale within the first week of hospital admission for acute MI; depression severity was assessed with the 17-item Hamilton Depression Rating Scale. The mean follow-up period was 1.8 years.


RESULTS
There were 44 events attributable to cardiac death (n = 16) or recurrent MI (n = 28), with 26 early and 18 late events. Type D patients were at cumulative increased risk of death/recurrent MI compared with non-Type D patients (16.3% vs 7.8%; P = .012). Cardiac history, left ventricular ejection fraction, and use of statins were predictors of total and late death/recurrent MI, with statins showing a substantial protective effect. In addition, cardiac history and use of statins were significantly associated with early death/recurrent MI. Type D patients had a 2-fold increased risk of total death/recurrent MI after adjustment for disease severity and depression (HR = 2.23; 95% CI, 1.14-4.35; P = .019) and a more than 3-fold increased risk of late death/recurrent MI (HR = 3.57; 95% CI, 1.23-10.30; P = .019).


CONCLUSIONS
Type D was a strong predictor of adverse cardiac outcome after acute MI, above and beyond disease severity and depression severity, and the associated risk was similar to that of traditional cardiovascular risk factors. Type D may be an important psychosocial factor to assess in patients post-MI for risk stratification purposes.
CoRPS Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands. e.j.martens@uvt.nl
Elisabeth J
EJ
Martens
Floortje
F
Mols
Matthew M
MM
Burg
Johan
J
Denollet
D002423:Cause of Death; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010551:Personality / Q000145:classification*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors