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

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 4,035 CAD patients for first coronary intervention therapy and their spouses, recruited 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 analyzed after a 3-year follow-up period.

Results: 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 analyzing 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-centered interventions are warranted.