Abstract
Multiple lines of evidence suggest that certain psychological factors may increase the risk of coronary events and cardiac death. Depression has been considered to be an important pathogenic factor. Certain personality types may also be associated with increased risk for cardiovascular illness. Type A behaviour (hard-driving, competitive, time-urgent, hostile–irritable) has been linked to high stress levels and the risk of eventual cardiovascular problems [1]. Recently, a new personality construct, the type D or ‘distressed’ personality, has been proposed [2]. Type D represents a personality profile characterized by both the tendency to experience negative emotions and the propensity to inhibit self-expression in social interaction. Type D individuals score highly on negative affectivity and social inhibition personality dimensions. This construct is a result of an investigation of coping styles in men with coronary heart disease. In a sample of patients undergoing cardiac rehabilitation, deaths from cardiac causes were increased fourfold in those with type D personality even after controlling for conventional risk factors [3].
Both type D dimensions (negative affectivity and social inhibition) are associated with greater cortisol reactivity to stress [4]. Cortisol has many effects that promote coronary heart disease and other medical illnesses such as hypertension, diabetes, osteoporosis, and peptic ulcer [5]. Elevated cortisol may be a mediating factor in the association between type D personality and the increased risk for coronary heart disease and possibly other medical disorders. The observation that type D individuals have increased propensity to develop coronary heart disease underlines the importance of examining both acute (e.g. major depression) and chronic (e.g. certain personality features) factors in people at risk for coronary events and other diseases. Type D personality (whether as a biological construct of temperament or a constellation of habitual behaviours) may be a risk factor at least equivalent in importance to the other, ‘conventional’ coronary heart disease prognostic factors.