Type D personality and metabolic syndrome severity jointly predict 2-year MACE after acute coronary syndrome: A...

To determine whether Type D personality and higher metabolic syndrome (MetS) severity jointly associate with 2-year major adverse cardiac events (MACE) after acute coronary syndrome (ACS).

This prospective cohort study included 5441 patients diagnosed with ACS between May 2021 and May 2023. Type D personality was assessed, and an age-sex-ethnicity-specific MetS scoring model (MetS score) was used to evaluate metabolic syndrome severity at baseline. MACE were analyzed after a 2-year follow-up period.

During the 2-year follow-up period, 518 patients developed MACE. A nonlinear association was observed between MetS score and MACE risk (p for nonlinearity = 0.025). Compared with the Type D(-)/Low MetS risk group, the Type D(+)/High MetS risk group exhibited the highest risk of MACE (HR: 2.331, 95 % CI: 1.810-3.002). Subgroup analyses further revealed a pronounced sex difference: the association was strongest among women, with the Type D(+)/High MetS risk group showing the highest risk (HR: 3.505, 95 % CI: 2.092-5.872), whereas men in the same group also demonstrated elevated risk, though to a lesser degree (HR: 2.065, 95 % CI: 1.544-2.761).

Type D personality and higher MetS severity were jointly associated with increased 2-year MACE risk after ACS, with sex-specific patterns. These findings support integrated psychosocial and metabolic risk management, particularly among women with high MetS severity.