Explaining heterogeneity in the predictive value of Type D personality for cardiac events and mortality

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Abstract

Background
Type D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings.
Objectives
The aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect.
Methods
We used four existing data cohorts of 1503 CAD patients (89% male, mean age = 57.2 ± 9.1) with baseline measures of Type D and endpoints > 5 years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: < 50 y, 50–59 y, 60–69 y and ≥ 70 y. Multiple logistic regression models included age, sex, and clinical covariates.
Results
At follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR = 1.82; 95%CI 1.33–2.50) and cardiac death/MI (OR = 2.49; 95%CI 1.55–3.99). However, Type D was not associated with non-cardiac death (OR = 1.23; 95%CI 0.57–2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs ≥ 2.20, all ps ≤ .004), but not in patients aged ≥ 70 y (OR = 1.43, p = .57).
Conclusions
Choice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥ 70 y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics.
Original languageDutch
Pages (from-to)119-124
JournalInternational Journal of Cardiology
Volume224
DOIs
Publication statusPublished - 2016

Keywords

  • Heterogeneity
  • Myocardial Infarction
  • CABG
  • Percutaneous coronary intervention
  • Cardiac death
  • Risk Assessment
  • Coronary Artery Disease
  • Type D
  • Personality

Cite this

@article{52b1bb44294a417aa21a373c6a50458a,
title = "Explaining heterogeneity in the predictive value of Type D personality for cardiac events and mortality",
abstract = "BackgroundType D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings.ObjectivesThe aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect.MethodsWe used four existing data cohorts of 1503 CAD patients (89{\%} male, mean age = 57.2 ± 9.1) with baseline measures of Type D and endpoints > 5 years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: < 50 y, 50–59 y, 60–69 y and ≥ 70 y. Multiple logistic regression models included age, sex, and clinical covariates.ResultsAt follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR = 1.82; 95{\%}CI 1.33–2.50) and cardiac death/MI (OR = 2.49; 95{\%}CI 1.55–3.99). However, Type D was not associated with non-cardiac death (OR = 1.23; 95{\%}CI 0.57–2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs ≥ 2.20, all ps ≤ .004), but not in patients aged ≥ 70 y (OR = 1.43, p = .57).ConclusionsChoice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥ 70 y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics.",
keywords = "Heterogeneity, Myocardial Infarction, CABG, Percutaneous coronary intervention, Cardiac death, Risk Assessment, Coronary Artery Disease, Type D, Personality",
author = "N. Kupper and J. Denollet",
year = "2016",
doi = "10.1016/j.ijcard.2016.09.006",
language = "Dutch",
volume = "224",
pages = "119--124",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

Explaining heterogeneity in the predictive value of Type D personality for cardiac events and mortality. / Kupper, N.; Denollet, J.

In: International Journal of Cardiology, Vol. 224, 2016, p. 119-124.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Explaining heterogeneity in the predictive value of Type D personality for cardiac events and mortality

AU - Kupper, N.

AU - Denollet, J.

PY - 2016

Y1 - 2016

N2 - BackgroundType D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings.ObjectivesThe aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect.MethodsWe used four existing data cohorts of 1503 CAD patients (89% male, mean age = 57.2 ± 9.1) with baseline measures of Type D and endpoints > 5 years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: < 50 y, 50–59 y, 60–69 y and ≥ 70 y. Multiple logistic regression models included age, sex, and clinical covariates.ResultsAt follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR = 1.82; 95%CI 1.33–2.50) and cardiac death/MI (OR = 2.49; 95%CI 1.55–3.99). However, Type D was not associated with non-cardiac death (OR = 1.23; 95%CI 0.57–2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs ≥ 2.20, all ps ≤ .004), but not in patients aged ≥ 70 y (OR = 1.43, p = .57).ConclusionsChoice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥ 70 y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics.

AB - BackgroundType D personality has been associated with adverse outcomes in patients with coronary artery disease (CAD). However, large heterogeneity exists between Type D studies, including some studies reporting null-findings.ObjectivesThe aim of this study was to examine i) choice of endpoint and ii) age as two study characteristics that may partly explain this large heterogeneity in the Type D associated prognostic effect.MethodsWe used four existing data cohorts of 1503 CAD patients (89% male, mean age = 57.2 ± 9.1) with baseline measures of Type D and endpoints > 5 years follow-up: major adverse cardiac events (MACE), cardiac death/MI, and non-cardiac death. Patients were classified in 4 age categories: < 50 y, 50–59 y, 60–69 y and ≥ 70 y. Multiple logistic regression models included age, sex, and clinical covariates.ResultsAt follow-up, there were 295 events, including 116 cardiac death/MI, and 37 non-cardiac deaths. Both continuous and categorical measures of Type D predicted adverse events. Type D was independently associated with MACE (OR = 1.82; 95%CI 1.33–2.50) and cardiac death/MI (OR = 2.49; 95%CI 1.55–3.99). However, Type D was not associated with non-cardiac death (OR = 1.23; 95%CI 0.57–2.69). Regarding age, Type D consistently predicted MACE in the lower age groups (all ORs ≥ 2.20, all ps ≤ .004), but not in patients aged ≥ 70 y (OR = 1.43, p = .57).ConclusionsChoice of endpoint and age modulated the risk conferred by Type D personality. Type D was associated with an increased risk of cardiac events, but not with non-cardiac death, or with events in patients aged ≥ 70 y. Research on psychosocial risk in CAD should account for different sources of heterogeneity in study characteristics.

KW - Heterogeneity

KW - Myocardial Infarction

KW - CABG

KW - Percutaneous coronary intervention

KW - Cardiac death

KW - Risk Assessment

KW - Coronary Artery Disease

KW - Type D

KW - Personality

U2 - 10.1016/j.ijcard.2016.09.006

DO - 10.1016/j.ijcard.2016.09.006

M3 - Article

VL - 224

SP - 119

EP - 124

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -