Type D personality and cardiovascular function in daily life of people without documented cardiovascular disease

doi:10.1016/j.ijpsycho.2011.02.014

International Journal of Psychophysiology

Volume 80, Issue 2, May 2011, Pages 139-142

https://doi.org/10.1016/j.ijpsycho.2011.02.014 Get rights and content

Abstract

Type D personality, the combination of negative affectivity and social inhibition, is associated with poor prognosis in patients with ischemic heart disease. The mechanisms are poorly understood. The aim of the present study was to examine whether Type D personality is associated with cardiovascular function in everyday life of people without documented cardiovascular disease. Eighty-six participants (53% women) aged 27 to 60 years who reported work-related non-cardiac health complaints were equipped with ambulatory cardiovascular monitors for 24 h measuring heart rate, respiratory sinus arrhythmia, pre-ejection period, and systolic and diastolic blood pressure. With and without controlling for age, sex, educational level, body mass index, physical activity, smoking and alcohol consumption, mood and social contact, Type D personality was not associated with any cardiovascular measure during the day or at night (all F (1, 79) < 1.00, p > .10). When analyzed separately as continuous variables, only the social inhibition component of Type D personality showed a tendency for an association with nighttime systolic blood pressure (F (1, 78) = 3.65, p = .06, η² = .04). In conclusion, Type D personality generally does not seem to be associated with unfavorable cardiovascular function in daily life of people without any documented cardiovascular disease.

Research highlights

►Type D personality has been found to be a risk factor for adverse cardiac outcome. ►Physiological mechanisms for this association are unknown. ►Type D — daily cardiovascular function link was examined in healthy people. ►No association was found between Type D personality and cardiovascular function. ►Type D personality is not a cardiovascular risk in healthy people.

Introduction

Type D personality is a combination of two personality characteristics: negative affectivity (NA) and social inhibition (SI) (Denollet, 2005, Denollet et al., 1996). NA refers to the tendency to experience a range of negative feelings and emotions across time and situations (Watson and Pennebaker, 1989), while SI reflects feeling uncomfortable and inhibited in social situations (Asendorpf, 1993). The combination of these two results in enhanced feelings of distress that are not easily shared with others (Denollet, 2005).

Type D personality has been associated with a poor prognosis in patients with cardiovascular disease, notably those people that have had a myocardial infarction (MI). For instance, post-MI patients with Type D personality have been found to have about a four-fold risk of rehospitalization and recurrent adverse events, such as another MI (Denollet and Brutsaert, 1998, Denollet et al., 2000), as well as an enhanced risk of cardiac death (Denollet et al., 1996, Pedersen et al., 2004). For a recent review on the adverse effects of Type D personality in cardiac patients, see Pedersen and Denollet (2006).

Despite the fact that the adverse effects of Type D in cardiac patients seem well-established, little is known about potential mechanisms that may explain this link. One possible mechanism may involve exaggerated cardiovascular activity in daily life, mediated by an enhanced sympathetic drive and decreased vagal control of the heart. There is evidence that such cardiovascular hyperactivity or prolonged activation during laboratory stressful tasks and during daily life is associated with enhanced risk of hypertension and coronary artery disease (Light et al., 1999, Menkes et al., 1989, Treiber et al., 2003).

However, there is a paucity of data on this potential mechanism in Type D personality. Research in still healthy individuals is needed to avoid potential confound of an already present disease state. Very few studies have examined this issue in the laboratory, while none have been published regarding cardiovascular activity in daily life. In a stressful laboratory protocol involving a mental arithmetic with harassment, students with a Type D personality did not differ from students without Type D regarding the cardiovascular measures assessed (heart rate and systolic and diastolic blood pressure [SBP and DBP])(Habra et al., 2003). Mental arithmetic administered to students was also used in a more recent study, which included additional more elaborate cardiovascular measures, such as cardiac output and peripheral resistance (Williams et al., 2009). Only in men, Type D personality was related to enhanced cardiac output response to the task, but not heart rate, blood pressure, or peripheral resistance. Most recently, only in a subgroup of white American students during one of three laboratory conditions (stressful imagery), lower vagal versus sympathetic heart rate variability was found in Type D versus non Type D individuals (Martin et al., 2010). Of note, the studies to date were based on young student samples, limiting their generalizability to the general population.

As no studies have been performed on the link between Type D personality and cardiovascular function in daily life of individuals without any documented cardiovascular disease, this was the focus of the present study. In addition, we extended previous laboratory findings by the inclusion of various parameters of cardiovascular function reflecting the relative sympathetic and vagal influences on the heart. Finally, we extended previous findings to a population older than the student samples used in previous studies.

We hypothesized that Type D personality and its components NA and SI would be associated with enhanced sympathetic activity, decreased vagal tone, and elevated blood pressure during daily life.

Section snippets

Participants

Participants were recruited among employees of several companies in Southern Netherlands who visited their occupational physician with various kinds of work-related problems at ArboUnie in Tilburg, an institute specialized in helping employees with all kinds of work-related health problems. Diagnosis was made according to the classification system of the Dutch Association of Occupational Medicine (Nederlandse Vereniging voor Arbeids en Bedrijfsgeneeskunde, 2000), in which categories are based

Sociodemographic characteristics and daily behavior

Participants with and without Type D personality did not differ on age, sex, level of education or body mass index (all p > .10; Table 1).

The average number of valid daily sitting periods that were used for analysis was 10.84 (SD = 3.56, range between 4 and 19). Type D participants did not differ from non Type D's on the number of valid sitting periods (p = 0.57) or on any of the potentially confounding variables, except higher levels of experienced distress (t (84) = 2.69, p = .009) and lower levels of

Discussion

The main aim of the present investigation was to examine the association between Type D personality and 24-hour cardiovascular function in daily life in participants without any documented cardiovascular disease. No association was obtained for heart period, blood pressure, or the parameters of sympathetic and parasympathetic control of the heart (pre-ejection period and respiratory sinus arrhythmia, respectively).

This is the first study that reports on ambulatory cardiovascular function of

Acknowledgements

We would like to thank Joyce Kokx and Roel Plevier for data collection and data preparation for this project.

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Evidence for a link between personality and emotional reactivity is also available from studies documenting cardiovascular responses to stress. People classified as having Type D personality characteristics (the combination of negative affectivity and social inhibition) show greater cardiac output (Nyklíček, Vorselaars, & Denollet, 2011), blood pressure reactivity (Habra, Linden, Anderson, & Weinberg, 2003), and heart rate reactivity (Martin et al., 2010) during experimentally induced stress. Further, people with high levels of neuroticism or low levels of extraversion show greater cardiac output, blood pressure reactivity, and heart rate reactivity when faced with mental or emotional stressors (Hughes, Howard, James, & Higgins, 2011; Jonassaint et al., 2009).
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View full text

Type D personality and cardiovascular function in daily life of people without documented cardiovascular disease

Abstract

Research highlights

Introduction

Section snippets

Participants

Sociodemographic characteristics and daily behavior

Discussion

Acknowledgements

J. Am. Coll. Cardiol.

J. Psychosom. Res.

Biol. Psychol.

Lancet

Brain Behav. Immun.

J. Psychosom. Res.

Int. J. Psychophysiol.

Int. J. Cardiol.

J. Am. Coll. Cardiol.

Social inhibition: a general–developmental perspective

DS14: standard assessment of negative affectivity, social inhibition, and Type D personality

Psychosom. Med.