Type D personality as a risk factor for 3-year cardiovascular events in patients with coronary artery disease and their spouse: a prospective cohort study

Abstract

Aims Type D personality has been established as an independent psychological risk factor for adverse outcomes in coronary artery disease (CAD) patients. However, research on the association between Type D personality and cardiovascular events in couples is limited. This study investigated the correlation between Type D personality and cardiovascular outcomes among CAD patients and their spouses. Methods This prospective cohort study included 4035 CAD patients for first coronary intervention therapy and their spouses, re- and results cruited from January 2017 to July 2020. Type D personality, anxiety, depression, and baseline clinical data were assessed for both partners. The major adverse cardiac event (MACE) rate of both CAD patients and their spouses was analysed after a 3-year follow-up period. A total of 871 CAD patients and 234 spouses developed MACE during the follow-up period. The Cox proportional hazards regression analysis revealed that the Type D(+) patient/Type D(+) spouse group exhibited the highest risk of 3-year MACE in both patients [hazard ratio (HR), 3.834; 95% confidence interval (CI), 2.947–4.987; P < 0.001) and spouses (HR, 2.670; 95% CI, 1.603–4.448; P < 0.001). When analysing Type D as continuous variables, a synergistic interaction between patient and spouse negative affectivity (NA_patient × NA_spouse) was significantly associated with MACE in both CAD patients (HR, 1.746; 95% CI, 1.517–2.010; P < 0.001) and their spouses (HR, 1.992; 95% CI, 1.843–2.152; P < 0.001). Conclusion This study suggests that having Type D personality, either in the CAD patient or their spouse, is associated with an increased risk of adverse cardiovascular outcomes in both individuals. Accordingly, the assessment of Type D personality in both partners and the development of tailored, couple-centred interventions are warranted.