Denollet Johan, Pedersen Susanne S, Vrints Christiaan J, Conraads Viviane M
CoRPS-Center of Research on Psychology in Somatic Disease, Tilburg University, Tilburg, The Netherlands.
Am J Cardiol. 2006 Apr 1;97(7):970-3. doi: 10.1016/j.amjcard.2005.10.035. Epub 2006 Feb 13.
Psychological stress and type D personality have been associated with adverse cardiac prognosis, but little is known about their relative effect on the pathogenesis of coronary heart disease (CHD). "Type D" refers to the tendency to experience negative emotions and to inhibit the expression of these emotions in social interactions. We investigated the relative effect of stress and type D personality on prognosis at 5-year follow-up. At baseline, 337 patients with CHD who participated in cardiac rehabilitation filled in the General Health Questionnaire (psychological stress) and the Type D personality scale. Patients were followed for 5 years. The end point was major adverse cardiac events, which were defined as a composite of cardiac death, myocardial infarction, and cardiac revascularization (coronary artery bypass grafting/percutaneous coronary intervention). There were 46 major adverse cardiac events at follow-up, including 4 deaths and 8 myocardial infarctions. Type D patients had an increased risk of death/infarction (odds ratio 4.84, 95% confidence interval 1.42 to 16.52, p = 0.01) compared with non-type D patients, independent of disease severity. Stress (p = 0.011) and type D (p = 0.001) were related to an increased risk of developing a major adverse cardiac event after adjusting for gender, age, and biomedical risk factors. Multivariate analysis yielded left ventricular ejection fraction < or =40%, no treatment with coronary artery bypass grafting, and type D personality (odds ratio 2.90, 95% confidence interval 1.42 to 5.92, p = 0.003) as independent predictors of major adverse cardiac events, whereas psychological stress was marginally significant (odds ratio 2.01, 95% confidence interval 0.99 to 4.11, p = 0.054). In conclusion, type D personality is a psychological factor that may optimize risk stratification in patients with CHD. Type D reflects more than temporary changes in general stress level because it predicted cardiac events after controlling for concurrent symptoms of stress.
心理压力和D型人格与不良心脏预后相关，但它们对冠心病（CHD）发病机制的相对影响却鲜为人知。“D型”是指在社交互动中体验负面情绪并抑制这些情绪表达的倾向。我们在5年随访中研究了压力和D型人格对预后的相对影响。在基线时，337名参加心脏康复的冠心病患者填写了一般健康问卷（心理压力）和D型人格量表。对患者进行了5年的随访。终点是主要不良心脏事件，定义为心脏死亡、心肌梗死和心脏血运重建（冠状动脉搭桥术/经皮冠状动脉介入治疗）的综合结果。随访期间有46例主要不良心脏事件，包括4例死亡和8例心肌梗死。与非D型患者相比，D型患者死亡/梗死风险增加（优势比4.84，95%置信区间1.42至16.52，p = 0.01），与疾病严重程度无关。在调整性别、年龄和生物医学危险因素后，压力（p = 0.011）和D型人格（p = 0.001）与发生主要不良心脏事件的风险增加相关。多变量分析得出左心室射血分数≤40%、未接受冠状动脉搭桥术治疗和D型人格（优势比2.90，95%置信区间1.42至5.92，p = 0.003）是主要不良心脏事件的独立预测因素，而心理压力的影响接近显著（优势比2.01，95%置信区间0.99至4.11，p = 0.054）。总之，D型人格是一种心理因素，可能有助于优化冠心病患者的风险分层。D型人格反映的不仅仅是一般压力水平的暂时变化，因为在控制了同时存在的压力症状后它仍能预测心脏事件。
