Type D personality and cardiovascular disease: evidence and clinical implications

Despite significant reductions in morbidity and mortality in recent years due to improved treatment strategies, cardiovascular disease is the leading cause of death in the Western world. Psychosocial factors, such as depression, have been shown to impact adversely on the prognosis of patients with coronary artery disease, but personality factors have to a large extent been ignored since the controversial findings surrounding the Type A behaviour pattern. This review on Type D personality highlights the importance of including personality factors in research and clinical practice, as personality may be an important explanatory factor of individual differences in multiple clinical outcomes. Type D personality is defined as a high score on negative affectivity (a tendency to experience increased negative emotions) and social inhibition (a tendency not to express these emotions when together with others). Type D has been associated with increased depression, fatigue, poor healthrelated quality of life, and increased risk of cardiac morbidity and mortality independent of established biomedical risk factors. Type D personality can be assessed with the Type D 14-item Scale (DS14). The scale is a brief, valid and standardised instrument that comprises little burden to patients and to clinical practice. The DS14 has recently been validated in Italian cardiac patients.