Abstract
Background: The distressed (‘Type D’) personality has been associated with impaired health status and increased inflammatory activation in heart failure (HF). Increased pro-inflammatory activation has been suggested as a mediating pathway, explaining associations between Type D personality and impaired health outcomes. In this study, we examined whether inflammatory biomarkers mediated the association between Type D personality and 12-month health status. Methods: HF outpatients, recruited from one center in the Netherlands ( n =228, 79.4% male, mean age 66.9±8.7 years), filled out the Type D questionnaire (DS14) at inclusion and the Short Form-12 (SF12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 12 months to assess generic and disease-specific health status, respectively. Blood samples at inclusion were analyzed for high sensitive C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNFα), and its soluble receptors (sTNFr1, sTNFr2). A multiple mediation model for Type D personality, 12-month generic and disease-specific health status, and mediating inflammatory biomarkers was tested using Structural Equation Modeling. Results: The prevalence of Type D personality was 20.6% (47/228). Type D personality was associated with lower generic and disease-specific health status ( p <.001). IL-6 was inversely associated with health status ( p <.01), and sTNFr1 was inversely associated with disease-specific health status ( p =.03). No mediating effects were found for the five inflammatory biomarkers. Type D personality remained independently associated with lower health status in the final model comprising all inflammatory biomarkers. Conclusions: The association between Type D personality and impaired health status was not mediated by increased levels of inflammatory biomarkers. Future studies need to confirm these findings, and investigate whether the association between Type D personality and impaired health outcomes may be explained by other biological or behavioral factors.
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