Personality affects effectiveness of stents

Stents that keep clogged coronary arteries open may be wonder of modern medicine, but how well they work seems to depend at least in part on the patient's personality, a Dutch research team reports

After being treated for heart disease with even the most advanced types of stents, people with a "type D personality," or "distressed personality," are at increased risk of death or attack.

The use of drug-coated stents has significantly decreased the rate of reclogging after coronary arteries have been cleared and propped open with the wire mesh tubes. Despite this advance, Dr. Susanne S. Pedersen of Tilburg University, and colleagues note in the Journal of the American College of Cardiology, the more modern treatment has not translated into reduced cardiovascular risk after the procedure.

To look into the possibility that non-traditional risk factors may play a role, Pedersen's group rated patients on the Type D Personality Scale six months after they underwent angioplasty and stenting. Type D personality refers to "individuals who experience increased negative emotions and who do not express these emotions in social interactions," the researchers explain.

Included were 358 patients treated with drug-coated stents and 517 treated with bare-metal stents. Altogether, 254 patients were classified as type D personalities.

By nine months, there were 9 deaths and 11 heart attacks. Patients with type D personality were at significantly increased cumulative risk, with events occurring in 5.6 percent of type D subjects and 1.3 percent of non-type D patients.

Personality type remained a factor regardless of other, traditional risk factors or the type of stent used.

"Subgroups of cardiac patients with a particularly psychological profile may not respond adequately to treatment, and ... for these subgroups some form of psychosocial intervention is warranted," the authors conclude.

SOURCE: Journal of the American College of Cardiology, September 1, 2004.