CoRPS Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands.
J Clin Psychiatry. 2010 Jun;71(6):778-83. doi: 10.4088/JCP.08m04765blu. Epub 2010 Feb 9.
To investigate the effect of Type D personality (high negative affectivity and social inhibition) on cardiac death and/or recurrent myocardial infarction (MI) in patients with acute MI, after adjustment for disease severity and depression. To explore the differential effect of Type D on early (< or = 6 months) versus late (> 6 months) events separately.
Patients hospitalized for acute MI (N = 473) were recruited between May 2003 and May 2006. Patients were assessed on demographic and clinical variables and completed the Type D Personality Scale within the first week of hospital admission for acute MI; depression severity was assessed with the 17-item Hamilton Depression Rating Scale. The mean follow-up period was 1.8 years.
There were 44 events attributable to cardiac death (n = 16) or recurrent MI (n = 28), with 26 early and 18 late events. Type D patients were at cumulative increased risk of death/recurrent MI compared with non-Type D patients (16.3% vs 7.8%; P = .012). Cardiac history, left ventricular ejection fraction, and use of statins were predictors of total and late death/recurrent MI, with statins showing a substantial protective effect. In addition, cardiac history and use of statins were significantly associated with early death/recurrent MI. Type D patients had a 2-fold increased risk of total death/recurrent MI after adjustment for disease severity and depression (HR = 2.23; 95% CI, 1.14-4.35; P = .019) and a more than 3-fold increased risk of late death/recurrent MI (HR = 3.57; 95% CI, 1.23-10.30; P = .019).
Type D was a strong predictor of adverse cardiac outcome after acute MI, above and beyond disease severity and depression severity, and the associated risk was similar to that of traditional cardiovascular risk factors. Type D may be an important psychosocial factor to assess in patients post-MI for risk stratification purposes.
在调整疾病严重程度和抑郁程度后，研究 D 型人格（高负性情感和社交抑制）对急性心肌梗死患者心脏死亡和/或复发性心肌梗死的影响。分别探讨 D 型人格对早期（<=6 个月）和晚期（>6 个月）事件的差异影响。
2003 年 5 月至 2006 年 5 月期间，招募了因急性心肌梗死住院的 473 名患者。患者入院后第一周内进行人口统计学和临床变量评估，并完成 D 型人格量表评估；抑郁严重程度采用 17 项汉密尔顿抑郁量表评估。平均随访时间为 1.8 年。
共有 44 例归因于心脏死亡（n=16）或复发性心肌梗死（n=28），其中 26 例为早期事件，18 例为晚期事件。与非 D 型人格患者相比，D 型人格患者的死亡/复发性心肌梗死累积风险增加（16.3%vs7.8%；P=0.012）。心脏病史、左心室射血分数和他汀类药物的使用是总死亡率和晚期死亡率/复发性心肌梗死的预测因素，他汀类药物具有显著的保护作用。此外，心脏病史和他汀类药物的使用与早期死亡/复发性心肌梗死显著相关。在调整疾病严重程度和抑郁程度后，D 型人格患者总死亡率/复发性心肌梗死的风险增加 2 倍（HR=2.23；95%CI，1.14-4.35；P=0.019），晚期死亡率/复发性心肌梗死的风险增加 3 倍以上（HR=3.57；95%CI，1.23-10.30；P=0.019）。
D 型人格是急性心肌梗死后不良心脏预后的一个强有力预测因素，超过了疾病严重程度和抑郁严重程度，且相关风险与传统心血管危险因素相似。D 型人格可能是评估心肌梗死后患者风险分层的一个重要社会心理因素。
