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Predictive value of Type D personality for impaired endothelial function in patients with coronary artery disease
Johan Denollet1, Romy A van Felius2, Paul Lodder2
1CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands; Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium.
Insights
Type D personality, characterized by high negative affectivity and social inhibition, is linked to impaired endothelial function in men with coronary artery disease. This finding highlights a significant adverse cardiovascular health effect independent of depression.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Vascular Biology
Background:
- Type D personality is associated with cardiovascular events and coronary plaque severity.
- The relationship between Type D personality and functional vasomotion abnormalities remains unclear.
- This study investigates Type D personality's association with endothelial dysfunction in coronary artery disease (CAD) patients.
Purpose of the Study:
- To examine the concurrent and predictive associations of Type D personality with endothelial dysfunction.
- To assess the impact of Type D personality on flow-mediated dilation (FMD) and endothelial progenitor cells (EPCs) in CAD patients.
- To determine if Type D personality independently predicts endothelial dysfunction over time.
Main Methods:
- 180 male CAD patients completed Type D and depression scales and underwent a 12-week exercise program.
- Flow-mediated dilation (FMD) and circulating endothelial progenitor cells (EPCs) were measured at baseline, 3, and 12 months.
- Logistic regression and linear mixed models analyzed endothelial function, adjusting for clinical factors and depression.
Main Results:
- Type D personality correlated with decreased FMD across all time points (p=0.04), independent of exercise and depression.
- Type D patients showed a higher prevalence of endothelial dysfunction at baseline (65% vs. 44%) and 12 months (OR=3.43).
- No significant association was found between Type D personality and reduced EPCs (p=0.07); age and smoking were significant correlates.
Conclusions:
- Type D personality is associated with impaired endothelial function in men with CAD.
- This association is time-robust, independent of depressive symptoms, and supports Type D's adverse cardiovascular impact.
- Findings suggest Type D personality is a significant factor in cardiovascular health outcomes for CAD patients.
Background:
Type D personality (high negative affectivity and social inhibition) is associated with cardiovascular events and coronary plaque severity. Whether Type D is also related to functional vasomotion abnormalities is unknown. We examined concurrent and predictive associations of Type D with endothelial dysfunction in patients with coronary artery disease (CAD).
Methods:
At baseline, 180 CAD patients (90% men; M = 58.0 years) completed Type D (DS14) and depression scales, and entered a 12-week exercise program. Flow-mediated dilation (FMD) of the brachial artery and circulating CD34+/KDR+/CD45+dim endothelial progenitor cells (EPCs) were assessed at baseline, 3 months, and 12 months. Logistic regression and linear mixed models were used to analyze endothelial function.
Results:
Type D personality was associated with decreased FMD across baseline, 3 months, and 12 months (mixed model analysis, p = 0.04), after adjustment for clinical characteristics, exercise training and depression. There was no significant association between Type D and decreased EPCs (p = 0.07). Age and smoking were other significant correlates of FMD and EPCs. Using a FMD <5.5% cut-off, Type D patients more often had endothelial dysfunction at baseline (24/37 = 65%) than non-Type Ds (63/143 = 44%); OR = 3.03, 95% CI 1.04-8.80. This significant Type D effect was confirmed in prospective analyses of endothelial dysfunction at 12 months (OR = 3.43, 95% CI 1.01-11.64), and in subgroup analyses of male patients.
Conclusions:
Type D personality was associated with impaired endothelial function in men with CAD. This association was robust across time, independent from depressive symptoms, and supports the notion that Type D has an adverse effect on cardiovascular health in patients with CAD.
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