People with coronary heart disease and a type D personality - a propensity to experience negative feelings - have a considerably increased risk of having a heart attack, needing heart surgery or dying from heart disease, according to Belgian and Dutch researchers.

As lead investigator Dr. Johan Denollet told Reuters Health, “type D personality was associated with a three-fold increased risk of new cardiac events…in cardiac patients, and this association could not be explained away by temporary changes in psychological stress levels.”

Type D, he added, “is characterized not only by chronic negative emotions, but also by the tendency to inhibit self-expression while avoiding possible negative reactions from others. Type D patients perceive many types of social interaction as stressful and tend to hide their true feelings; this may result in the under-reporting of stress-related health problems.”

In the American Journal of Cardiology, Denollet of University Hospital Antwerp and colleagues report the results of their 5-year follow-up study of 337 patients with coronary heart disease. The participants completed a psychological stress questionnaire and the Type D personality scale at the beginning of the study.

Over the study period there were 46 major adverse cardiac events. Of these, 8 were heart attacks and 4 were deaths.

Compared with other personality types, type D personality conferred a nearly fivefold risk of death or heart attack, regardless of disease severity.

Patient factors that predicted the risk of a major adverse cardiac event were a reduced pumping ability of the heart, not having coronary bypass surgery and having a type D personality, the investigators add. Psychological stress had less influence on risk.

Factors other than stress, such as type D personality, need to be explored so that more successful treatment strategies can be developed for high-risk patients, Denollet concluded.

SOURCE: American Journal of Cardiology, April 2006.