Stress-prone personality tied to cardiac event risk in patients with CAD, spouses
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Key takeaways:
- Type D personality, common in people prone to stress, was an independent predictor of 3-year major adverse cardiac events.
- Risk was especially high when both the patient and spouse had Type D personality.
The presence of Type D personality among patients with CAD or their spouses was associated with elevated risk for cardiac events, according to a study published in the European Journal of Preventive Cardiology.
“A recent meta-analysis involving 19 prospective cohort studies further supported the association between Type D personality and increased risk for adverse events in CAD patients,” Yini Wang, PhD, of the department of cardiology at The Second Affiliated Hospital of Harbin Medical University in Harbin, China, and colleagues wrote. “However, the relationship between Type D personality and cardiovascular outcomes in couples remains relatively understudied.
“Elucidating such a link could potentially inform the development of more effective screening strategies targeted at couples rather than individuals,” the researchers wrote.
According to a prior study published in Current Cardiology Reports, Type D is characterized by negative affectivity and social inhibition, and those with Type D personality are especially prone to stress.
To examine the association between Type D personality and the occurrence of major adverse cardiac events among patients with CAD and their spouses, Wang and colleagues conducted a prospective cohort study of 4,035 patients with CAD aged 18 to 70 years (mean age, 57 years; 73% men) undergoing their first coronary intervention therapy at The Second Affiliated Hospital of Harbin Medical University between January 2017 and July 2020, along with their spouses (mean age, 57 years; 27% men).
The researchers assessed Type D personality using the Chinese version of the Type D Scale-14, a questionnaire comprised of two subscales on negative affectivity and social inhibition.
Additionally, they assessed the severity of depression using the 21-item Beck Depression Inventory and anxiety using the 21-item Beck Anxiety Inventory.
Participants were followed for up to 36 months through telephone calls or clinic visits.
The primary outcome was a composite of major adverse cardiac events, which included cardiac hospitalization, acute MI, PCI/CABG and cardiac death among both patients and their spouses. The primary efficacy outcome was time to the first occurrence of the primary outcome.
Type D personality and risk for cardiac events
The researchers categorized participants into four groups based on their Type D personality status:
- Type D patient and spouse (n = 391; 9.69%);
- Type D patient but not Type D spouse (n = 443; 10.97%);
- Type D spouse but not Type D patient (n = 567; 14.05%); and
- Neither spouse with Type D personality (n = 2,634; 65.27%).
In a multivariable analysis, the highest risk for 3-year major adverse cardiac events was observed among patients with CAD (HR = 3.834; 95% CI, 2.947-4.987) and their spouses (HR = 2.67; 95% CI, 1.603-4.448) in the group where both spouses had a Type D personality.
The researchers also observed elevated risk for the primary outcome among the group where the patient was Type D but the spouse was not (HR for patient = 2.904; 95% CI, 2.409-3.5; HR for spouse = 2.019; 95% CI, 1.358-3.002) and the group where the spouse was Type D but the patient was not (HR for patient = 2.096; 95% CI, 1.654-2.656; HR for spouse = 2.338; 95% CI, 1.485-3.679).
Additionally, they found elevated risk for major adverse cardiac events in couples where both partners had negative affectivity (HR for patients with CAD = 1.746; 95% CI, 1.517-2.01; HR for spouses = 1.992; 95% CI, 1.843-2.152).
‘Specific psychological profiles’ and CV risk
“Our findings reveal that Type D personality, present in either the CAD patient or their spouse, is an independent predictor of subsequent [major adverse cardiac events],” the researchers wrote. “Moreover, the elevated risk of [major adverse cardiac events] associated with higher negative affectivity in patients is exacerbated when their spouses also display higher negative affectivity.”
Wang and colleagues acknowledged several study limitations, including its implementation in China, which may limit generalizability, and the fact that noncardiac comorbidities were not collected as potential confounding variables.
“Assessing Type D personality in both individuals within a CAD couple could yield valuable insights into the specific psychological profiles associated with an elevated risk of adverse cardiovascular outcomes,” the researchers wrote. “Future research is warranted to evaluate the efficacy of couple-centered interventions in simultaneously mitigating cardiovascular risk for these high-risk couples.”
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