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Original Research

Type D Personality Predicts Clinical Events After Myocardial Infarction, Above and Beyond Disease Severity and Depression

Elisabeth J. Martens, PhD; Floortje Mols, PhD;       Matthew M. Burg, PhD; and Johan Denollet, PhD

Published: February 9, 2010

Article Abstract

Objective: 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 (≤‘ ‰6 months) versus late (>‘ ‰6 months) events separately.

Method: 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.

Results: 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).

Conclusions: 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.

J Clin Psychiatry 2010;71(6):778-783

Submitted: October 2, 2008; accepted February 12, 2009.

Online ahead of print: February 9, 2010 (doi:10.4088/JCP.08m04765blu).

Corresponding author: Elisabeth J. Martens, PhD, CoRPS, Department of Medical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands (

Volume: 71

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