Type D personality is related to severity of acute coronary syndrome in patients with recurrent cardiovascular disease

Objectives To investigate the relationship between Type D (distressed) personality and cardiac biomarkers of disease severity in patients with acute coronary syndrome. To identify potential mechanisms behind the effect of Type D personality on cardiovascular disease ( CVD ). Design Cross‐sectional. Methods Patients ( N  = 215) with acute coronary syndrome completed a survey including a measure of Type D personality. Blood samples including a lipid profile and cardiac enzymes were taken within 3 days after the cardiovascular event. Data were analysed using simple correlations, multiple regressions, and mediation analyses. Results Type D personality was more predictive of severity of the acute coronary syndrome among patients with previous CVD compared to patients without previous CVD . Among patients with previous CVD , Type D personality was associated with the presence of ST elevation ( R 2  =.07) and more damage to the myocardium as indicated by higher troponin‐ I ( R 2  = .05) and myoglobin ( R 2  = .07) levels. These effects were independent from demographics, CV risk factors, and depression. Lower HDL cholesterol levels mediated the relationship between Type D personality and disease severity ( Κ 2  = .12 [95% CI 0.02, 0.28]) for myoglobin and Κ 2  = .08 [95% CI 0.01, 0.21] for troponin‐ I ). Conclusion Type D personality was related to a worse lipid profile and more severe acute coronary syndrome in patients with previous history of CVD . Given the strong relationship between disease severity and subsequent mortality, these results suggest that severity of the myocardial infarction may be a potential mechanism explaining increased mortality in Type D patients with recurrent CVD .Statement of contribution What is already known on this subject?Type D personality has been related to worse outcomes in cardiac patients. However, recent studies show mixed results, suggesting the need to clarify potential mechanisms.What does this study add?Type D personality is related to severity of acute coronary syndrome in patients with previous history of cardiovascular disease. This effect is partially accounted for by lower HDL levels in Type D patients. Disease severity is a potential mechanism by which Type D personality may affect cardiovascular health of patients with recurrent CVD.