CENTER ON BEHAVIORAL MEDICINE
Behavioral Genetics: Research Article
Denollet, Johan, Sys, Stanislas U,
Nathalie, Rombouts, Hans, et al. (1996, February 17). Personality as
predictor of long-term mortality in patients with coronary heart
Lancet, 347(8999), 417.
ABSTRACT: Emotional distress has been related to mortality in patients with coronary heart disease (CHD), but little is known about the role of personality in long-term prognosis. We postulated that type-D personality (the tendency to suppress emotional distress) was a predictor of long-term mortality in CHD, independently of established biomedical risk factors.
Methods We studied 268 men and 35 women with angiographically documented CHD, aged 31-79 years, who were taking part in an outpatient rehabilitation programme. All patients completed personality questionnaires at entry to the programme. We contacted them 6-10 years later (mean 7.9) to find out survival status. The main endpoint was death from all causes.
Findings At follow-up, 38 patients had died; there were 24 cardiac deaths. The rate of death was higher for type-D patients than for those without type-D (23 [27%]/85 vs 15 [7%]/218; p<O 0.00001). The association between type-D personality and mortality was still evident more than 5 years after the coronary event and was found in both men and women.
1 Lau J, Amman EM, Jimenez-Silva J, et at. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl Med 1992; 327: 248-54.
2 Emend M, Mock MB, Davis KB, et at. Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) registry. Circulation 1994; 90: 2645-57.
3 Dimsdale JE. A perspective on type A behaviour and coronary disease. N Engl J Med 1988; 318: 110-12.
4 Phillips DP, Ruth TI!, Wagner LM. Psychology and survival, Lancer 1993; 342: 1142-45.
5 Berkman LF, Leo-Summers L, Horwitz RI. Emotional support and survival after myocradial infarction: a prospective, population-based study of the elderly. Ann Intern Med 1992; 117: 1003-09.
6 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91: 999. 1005.
7 Asendorpf JB, Social inhibition: a general-developmental perspective. In: Traue Hc, Pennebaker JW, eds. Emotion, inhibition, and health. Seattle, WA: Hogrefe & Huber, 1993: 80-99.
8 Denollet J. Negative affectivity and repressive coping: pervasive influence on self-reported mood, health, and coronary-prone behavior. Psychosom Med 1991; 53: 538--56.
9 Gottlieb S, Moss AL McDermott M, Eberly S. Comparison of posthospital survival after acute myocardial infarction in women and men. Am J Cardiol 1994; 74; 727-30.
I0 Powell LH, Shaker LA, Jones BA, Vaccarino LV, Thoresen CE, Pattillo, JR. Psychosocial predictors of mortality in 83 women with premature acute myocardial infarction. Psychosom Med 1993; 55: 426–33.
1 I Denollet J, Sys SU, Brutsaert DL. Personality and mortality after myocardial infarction. Psychosom Med 1995; 57: 582–91.,
12 Denollet J, De Potter B. Coping subtypes for men with coronary heart disease: relationship to well-being, stress, and type A behaviour. Psycho Med 1992; 22: 667–84.
13 Pennebaker JW, Traue HC. Inhibition and psychosomatic processes. In: Traue HC, Pennebaker JW, eds. Emotion, inhibition, and health. Seattle, WA: Hogrefe St Huber, 1993: 146-63.
14 van der Ploeg HM, Defares PB, Spielberger CL7. ZBV. Len Nederlandstalige Bewerking van de Spielberger State-Trair Anxiety Inventory. Lisse, Netherlands; Swets 8z Zeitlinger, 1980.
15 Erdman RA, Duivenvoorden HJ, Verhage F, et al. Predictability of beneficial effects in cardiac rehabilitation: a randomized clinical trial of psychosocial variables. J Cardiopulm Rehab: 1986; 6: 206–13.
16 Millon T, Green C, Meagher R. Millon behavioral health inventory: manual. 3rd edn. Minneapolis: National Computer Systems Inc, 1982.
17 De Feyter PJ, van Ecnige MI, Dighton DH, Visser FC, de Jong J, Roos JP. Prognostic value of exercise testing, coronary angiography and left ventriculography 6–8 weeks after myocardial infarction. Circulation 1982; 66: 527-36.
18 Denollet J. Brutsaert DL. Enhancing emotional well-being by comprehensive rehabilitation in patients with coronary heart disease. Eur Heart J 1995; 16: 1070–78.
19 Malkoff SB, Muldoon MF, Zeigler ZR, Manuck SB. Blood platelet responsivity to acute mental stress. Psychosom Med 1993; 55: 477-82.
20 Yeung AC, Vekshtein VI, Krantz DS, et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Hog, _7 Med 1991; 325: 1551-56.
21 Rozanski A, Bairey CN, Krantz DS, et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Eng J Med 1988; 318: 1005-12.
22 Gottdiener JS, Krantz DS, Howell RH, et al. Induction of silent myocardial ischemia with mental stress testing: relation to the triggers of ischemia during daily life activities and to ischemic functional severity. J Am Coll Cardiol 1994; 24: 1645-51.
23 Carney RM, Rich M'W. teVelde A, Saini J, Clark K, Freedland KE. The relationship between heart rate, heart rate variability and depression in patients with coronary artery disease. J Psychosom Res 1988; 32: 159-64.
24 Horwitz RI, Vise-oh CM, Berkman L., et al. Treatment adherence and risk of death after a myocardial infarction. Lancer 1990; 336; 54245.
25 Blumenthal JA, Burg MM, Barefoot j, Williams RB, Haney T, Limet G. Social support, type A behaviour, and coronary artery disease. Psychosom Med 1987; 49: 331–40.
26 Romer DL, Ewart CK. Emotional inhibition in essential hypertension: obstacle to communication during medical visits? Health Psvchol 1 992; 11: 163--69.
27 Katsuya T, Koike G, Yee TW, et al. Association of angiotensinogen gene T235 variant with increased risk of coronary heart disease. Lancet 1995; 345: 1600-03.
28 Bouchard TJ. Genes, environment, and personality. Science 1994; 264: 1700-01.
29 Kole WJ, Appels AP, Mendes de
de Swart HD, Bar EW Viral exhaustion predicts new cardiac events after
successful coronary angioplasty. Psychosom Med 1994; 56: 281–87.