Abstract
BackgroundType D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings. ObjectivesThe aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect. MethodsWe used four existing data cohorts of 1503 CAD patients (89% male, mean age=57.2±9.1) with baseline measures of Type D and endpoints >5years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: <50y, 50–59y, 60–69y and ≥70y. Multiple logistic regression models included age, sex, and clinical covariates. ResultsAt follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR=1.82; 95%CI 1.33–2.50) and cardiac death/MI (OR=2.49; 95%CI 1.55–3.99). However, Type D was not associated with non-cardiac death (OR=1.23; 95%CI 0.57–2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs≥2.20, all ps≤.004), but not in patients aged ≥70y (OR=1.43, p=.57). ConclusionsChoice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥70y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics.
Highlights
Cardiovascular disease is a leading cause of death in the Western world, with coronary artery disease (CAD) being the major culprit
The current study aimed to examine the effects of two potential sources of heterogeneity affecting the association between Type D personality and adverse events in patients with CAD
Results indicated that both the choice of endpoint and the age distribution of the sample significantly impacted risk estimates of adverse events associated with Type D personality
Summary
Cardiovascular disease is a leading cause of death in the Western world, with coronary artery disease (CAD) being the major culprit. A fairly large body of research has examined the association of Type D personality (i.e. the general tendency towards emotional distress characterized by high scores on social inhibition and negative affectivity traits) with prognosis in patients with cardiovascular disease [6]. Methods: We used four existing data cohorts of 1503 CAD patients (89% male, mean age = 57.2 ± 9.1) with baseline measures of Type D and endpoints N5 years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Results: At follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths Both continuous and categorical measures of Type D predicted adverse events. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥70 y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics
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