Abstract
Purpose
To examine whether Type D—distressed—personality is independently associated with patient reported health outcomes, such as chest pain, health status and emotional distress, in patients with angiographically nonsignificant coronary abnormalities. Psychosocial factors, such as Type D personality, are risk factors for established coronary artery disease (CAD), but are unknown for patients with non-obstructive CAD.
Methods
A total of 273 patients (62 years, SD 10, 49 % male) participated in the cross-sectional part of the ‘TWeesteden mIld STenosis’ study. Inclusion was based on coronary angiography or CT-scan. Type D personality was examined in relation to chest pain, disease-specific (Seattle Angina Questionnaire) and generic health status (Short Form 12), and emotional distress (Hospital Anxiety and Depression Scale, Fatigue), adjusted for confounders and potential explanatory lifestyle factors.
Results
Patients with Type D personality (30 %) had an increased prevalence of chest pain (57 vs. 40 %). When adjusted for confounder’s age, gender, comorbidity, and medication use, Type D personality was significantly associated with increased chest pain, poorer disease-specific and generic health status and increased emotional distress. After further adjustment for explanatory lifestyle factors such as smoking, physical activity, and metabolic syndrome, Type D personality was associated with worse disease perception, lower treatment satisfaction, poor physical and mental health status, and higher emotional distress, but no longer with chest pain, angina stability, or physical limitations.
Conclusion
Type D personality was significantly associated with poor patient-perceived symptoms in patients with mild coronary abnormalities, which can be hypothesized to be detrimental in the long run.
Similar content being viewed by others
References
Mathers, C., Boerma, T., & Ma Fat, D. (2008). Causes of death. In The global burden of disease: 2004 update (NLM classification: W 74 ed., pp. 8–22, WHO Library Cataloguing-in-Publication Data). Geneva, Switzerland: World Health Organization Press.
Ambrose, J. A., & Srikanth, S. (2010). Vulnerable plaques and patients: Improving prediction of future coronary events. The American Journal of Medicine, 123(1), 10–16. doi:10.1016/j.amjmed.2009.07.019.
Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Z., Verschuren, M., et al. (2012). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European Heart Journal, 33(13), 1635–1701. doi:10.1093/eurheartj/ehs092.
Cassar, A., Holmes, D. R., Jr, Rihal, C. S., & Gersh, B. J. (2009). Chronic coronary artery disease: Diagnosis and management. Mayo Clinic Proceedings. Mayo Clinic, 84(12), 1130–1146. doi:10.4065/mcp.2009.0391.
Halligan, S., & Lerman, A. (2004). Approach to the patient with chest pain and nonobstructive coronary artery disease. Progress in Cardiovascular Diseases, 46(5), 453–464. doi:S0033062003001440.
Johnson, B. D., Shaw, L. J., Pepine, C. J., Reis, S. E., Kelsey, S. F., Sopko, G., et al. (2006). Persistent chest pain predicts cardiovascular events in women without obstructive coronary artery disease: Results from the NIH-NHLBI-sponsored Women’s Ischaemia Syndrome Evaluation (WISE) study. European Heart Journal, 27(12), 1408–1415. doi:10.1093/eurheartj/ehl040.
Bugiardini, R., & Bairey Merz, C. N. (2005). Angina with “normal” coronary arteries: A changing philosophy. JAMA, the Journal of the American Medical Association, 293(4), 477–484. doi:10.1001/jama.293.4.477.
Rozanski, A., Blumenthal, J. A., Davidson, K. W., Saab, P. G., & Kubzansky, L. (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. Journal of the American College of Cardiology, 45(5), 637–651. doi:10.1016/j.jacc.2004.12.005.
Khot, U. N., Khot, M. B., Bajzer, C. T., Sapp, S. K., Ohman, E. M., Brener, S. J., et al. (2003). Prevalence of conventional risk factors in patients with coronary heart disease. JAMA, the Journal of the American Medical Association, 290(7), 898–904. doi:10.1001/jama.290.7.898.
Faletra, F. F., Klersy, C., D’Angeli, I., Penco, M., Procaccini, V., Pasotti, E., et al. (2009). Relation between coronary atherosclerotic plaques and traditional risk factors in people with no history of cardiovascular disease undergoing multi-detector computed coronary angiography. Heart, 95(15), 1265–1272. doi:10.1136/hrt.2009.167098.
Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67(1), 89–97. doi:10.1097/01.psy.0000149256.81953.49.
Denollet, J., Schiffer, A. A., & Spek, V. (2010). A general propensity to psychological distress affects cardiovascular outcomes: Evidence from research on the type D (distressed) personality profile. Circulation. Cardiovascular Quality and Outcomes, 3(5), 546–557. doi:10.1161/CIRCOUTCOMES.109.934406.
Grande, G., Romppel, M., & Barth, J. (2012). Association between type D personality and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis. Annals of Behavioral Medicine, 43(3), 299–310. doi:10.1007/s12160-011-9339-0.
Mommersteeg, P. M. C., & Pouwer, F. (2012). Personality as a risk factor for the metabolic syndrome: A systematic review. Journal of Psychosomatic Research, 73, 326–333. doi:10.1016/j.jpsychores.2012.08.019.
Svansdottir, E., Karlsson, H. D., Gudnason, T., Olason, D. T., Thorgilsson, H., Sigtryggsdottir, U., et al. (2011). Validity of Type D personality in Iceland: Association with disease severity and risk markers in cardiac patients. Journal of Behavioral Medicine, 35(2), 155–166. doi:10.1007/s10865-011-9337-5.
Bugiardini, R., Manfrini, O., & De Ferrari, G. M. (2006). Unanswered questions for management of acute coronary syndrome: Risk stratification of patients with minimal disease or normal findings on coronary angiography. Archives of Internal Medicine, 166(13), 1391–1395.
Spertus, J. (2001). Selecting end points in clinical trials: What evidence do we really need to evaluate a new treatment? American Heart Journal, 142(5), 745–747. doi:10.1067/mhj.2001.119135.
Mommersteeg, P. M. C., Denollet, J., Spertus, J. A., & Pedersen, S. S. (2009). Health status as a risk factor in cardiovascular disease: A systematic review of current evidence. American Heart Journal, 157(2), 208–218. doi:10.1016/j.ahj.2008.09.020.
Krumholz, H. M., Peterson, E. D., Ayanian, J. Z., Chin, M. H., DeBusk, R. F., Goldman, L., et al. (2005). Report of the National Heart, Lung, and Blood Institute working group on outcomes research in cardiovascular disease. Circulation, 111(23), 3158–3166. doi:10.1161/CIRCULATIONAHA.105.536102.
Bugiardini, R., Badimon, L., Collins, P., Erbel, R., Fox, K., Hamm, C., et al. (2007). Angina, “normal” coronary angiography, and vascular dysfunction: Risk assessment strategies. PLoS Medicine, 4(2), e12.
Spertus, J. A., Winder, J. A., Dewhurst, T. A., Deyo, R. A., Prodzinski, J., McDonell, M., et al. (1995). Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. Journal of the American College of Cardiology, 25(2), 333–341. doi:0735109794003979.
Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. doi:10.1097/00005650-199603000-00003.
Mols, F., Pelle, A. J., & Kupper, N. (2009). Normative data of the SF-12 health survey with validation using postmyocardial infarction patients in the Dutch population. Quality of Life Research, 18(4), 403–414. doi:10.1007/s11136-009-9455-5.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. doi:10.1111/j.1600-0447.1983.tb09716.x.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77. doi:S0022399901002963.
Michielsen, H. J., De Vries, J., & Van Heck, G. L. (2003). Psychometric qualities of a brief self-rated fatigue measure: The Fatigue Assessment Scale. Journal of Psychosomatic Research, 54(4), 345–352. doi:S0022399902003926.
Alberti, K. G., Eckel, R. H., Grundy, S. M., Zimmet, P. Z., Cleeman, J. I., Donato, K. A., et al. (2009). Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation, 120(16), 1640–1645. doi:10.1161/CIRCULATIONAHA.109.192644.
Peduzzi, P., Concato, J., Kemper, E., Holford, T. R., & Feinstein, A. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49(12), 1373–1379. doi:S0895-4356(96)00236-3.
Mommersteeg, P. M. C., Kupper, H. M., & Denollet, J. (2010). Type D personality is associated with increased metabolic syndrome prevalence and an unhealthy lifestyle in a cross-sectional Dutch community sample. BMC Public Health, 10(19), 714. doi:10.1186/1471-2458-10-714.
Hausteiner, C., Klupsch, D., Emeny, R., Baumert, J., & Ladwig, K. H. (2010). Clustering of negative affectivity and social inhibition in the community: Prevalence of type D personality as a cardiovascular risk marker. Psychosomatic Medicine, 72(2), 163–171. doi:10.1097/PSY.0b013e3181cb8bae.
Kupper, N., Pedersen, S. S., Hofer, S., Saner, H., Oldridge, N., & Denollet, J. (2011). Cross-cultural analysis of Type D (distressed) personality in 6222 patients with ischemic heart disease: A study from the International HeartQoL Project. International Journal of Cardiology,. doi:10.1016/j.ijcard.2011.10.084.
Mols, F., Martens, E. J., & Denollet, J. (2010). Type D personality and depressive symptoms are independent predictors of impaired health status following acute myocardial infarction. Heart, 96(1), 30–35. doi:10.1136/hrt.2009.170357.
Ulvik, B., Bjelland, I., Hanestad, B. R., Omenaas, E., Wentzel-Larsen, T., & Nygard, O. (2008). Comparison of the Short Form 36 and the Hospital Anxiety and Depression Scale measuring emotional distress in patients admitted for elective coronary angiography. Heart and Lung, 37(4), 286–295. doi:10.1016/j.hrtlng.2007.08.001.
Ketterer, M. W., Knysz, W., Keteyian, S. J., Schairer, J., Jafri, S., Alam, M., et al. (2008). Cardiovascular symptoms in coronary-artery disease patients are strongly correlated with emotional distress. Psychosomatics, 49(3), 230–234. doi:10.1176/appi.psy.49.3.230.
Johnson, B. D., Shaw, L. J., Buchthal, S. D., Bairey Merz, C. N., Kim, H. W., Scott, K. N., et al. (2004). Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: Results from the National Institutes of Health-National Heart, Lung, and Blood Institute-Sponsored Women’s Ischemia Syndrome Evaluation (WISE). Circulation, 109(24), 2993–2999. doi:10.1161/01.CIR.0000130642.79868.
Tulloch, H., & Pelletier, R. (2008). Does personality matter after all? Type D personality and its implications for cardiovascular prevention and rehabilitation. Current Issues in Cardiac Rehabilitation and Prevention, 16, 2–4.
Timmis, A. D., Feder, G., & Hemingway, H. (2007). Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution. Heart, 93(7), 786–791.
Smith, T. W. (2011). Toward a more systematic, cumulative, and applicable science of personality and health: Lessons from type D personality. Psychosomatic Medicine, 73(7), 528–532. doi:10.1097/PSY.0b013e31822e095e.
Acknowledgments
The authors would like to thank the staff and employees of the TweeSteden Hospital Cardiology, laboratory, CAG and CT units. The authors would like to thank Tilburg University research assistants Sylvie Teurlings, Marjanne Bakker, Fleur Kuipers, Ferry van Eekelen, and Laura G.A.M. van Doornmalen for their contribution in the data collection of this study. P.M.C.M. received a travel grant of 250 euro of BIOTRONIK Nederland B.V.
Conflict of interest
All authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mommersteeg, P.M.C., Pot, I., Aarnoudse, W. et al. Type D personality and patient-perceived health in nonsignificant coronary artery disease: the TWeesteden mIld STenosis (TWIST) study. Qual Life Res 22, 2041–2050 (2013). https://doi.org/10.1007/s11136-012-0340-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-012-0340-2