Personality, Disease Severity, and the Risk of Long-term Cardiac Events in Patients With a Decreased Ejection Fraction After Myocardial Infarction

Abstract

Personality influences the clinical course of patients with a decreased LVEF. Emotional distress in these patients is unrelated to disease severity but reflects individual differences in personality. Clinical trials should take a broad view of the target of intervention; assessment of LVEF and personality may identify patients at risk.

Challenges in reducing depression-related mortality in cardiac populations: cognition, emotion, fatigue or personality?

“…Type D has been associated with increased depressive symptoms in several studies (Denollet & Brutsaert, 1998;Denollet, Pederson, Ong, et al, 2006;Denollet et al, 1996), and has also been shown to be associated with other constructs related to cardiovascular outcomes, such as vital exhaustion (Pedersen & Denollet, 2003;Pedersen & Middel, 2001). Assessment of vital exhaustion and Type D personality in cardiac patients showed that those with a Type D disposition were likely to have a high vital exhaustion score (Pedersen & Middel, 2001).…”

“…In studies which measured both depression and Type D, results showed that Type D remained the strongest psychological predictor of outcomes (Denollet & Brutsaert, 1998;Denollet, Pederson, Ong, et al, 2006;Denollet et al, 1996). Depression even became non-significant in some studies (Table 1) (Denollet & Brutsaert, 1998;Denollet, Pederson, Ong, et al, 2006). Social inhibition may in fact be the crucial aspect of risk prediction.…”

“…These associations are perhaps unsurprising as some theorists postulate that a general predisposition to negative affectivity makes individuals more prone to episodic phases of strong negative emotions, such as depression (Suls & Bunde, 2005). However, the growing importance of Type D personality in the cardiovascular sphere is highlighted by research which shows it to be an independent risk factor for cardiovascular morbidity and mortality (Table 1) (Denollet, 1998b;Denollet & Brutsaert, 1998;Denollet, Sys, & Brutsaert, 1995;Denollet et al, 1996;Denollet, Vaes, & Brutsaert, 2000;Pedersen & Middel, 2001). For example, Type D was an independent predictor of cardiac morbidity and mortality at five years follow-up of 319 patients with established CHD, even when controlling for standard cardiovascular risk factors .…”

“…Importantly, several studies have shown that Type D personality contributes to cardiovascular morbidity and mortality over and above the risk associated with other constructs such as depression and anxiety (Denollet & Brutsaert, 1998;Denollet, Pederson, Ong, et al, 2006;Denollet et al, 1996;Pedersen & Denollet, 2003). In studies which measured both depression and Type D, results showed that Type D remained the strongest psychological predictor of outcomes (Denollet & Brutsaert, 1998;Denollet, Pederson, Ong, et al, 2006;Denollet et al, 1996). Depression even became non-significant in some studies (Table 1) (Denollet & Brutsaert, 1998;Denollet, Pederson, Ong, et al, 2006).…”

Psychological risk factors in heart disease

“…Ironically, this misunderstanding was stated in an editorial comment [16] on a Type D article whereas in the actual Type D article [22] it was clearly asserted that: "… it is important to examine a broader scope of psychosocial factors than has previously been considered in relation to CHD" [p. 167, italics added]. In the very same article, it was also stated that: "clinical diagnoses of affective disorder, self-report measures of negative emotions and personality test scores may be independent predictors of adverse cardiac events" and furthermore that: "… the most powerful prediction scheme is likely to be one that incorporates both biomedical and psycho-social factors, including specific emotions and global personality traits" [22, p. 172, italics added].…”