Type D personality as a risk factor for adverse outcome in patients with cardiovascular disease: an individual patient data meta-analysis

Objective: Type D personality, a joint tendency toward negative affectivity (NA) and social inhibition (SI), has been linked to adverse events in patients with heart disease, though with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies (N = 11151), to investigate the prediction of adverse outcomes by Type D personality in acquired cardiovascular disease (CVD) patients. Method: For each outcome (all-cause mortality, cardiac mortality, myocardial infarction (MI), coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event (MACE), any adverse event), we estimated Type D's prognostic influence and the moderation by age, sex, and disease type. Results: In CVD patients, evidence for a Type D effect in terms of the Bayes factor (BF) was strong for MACE (BF = 42.5; OR = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99) and MI (BF = 16.9; OR = 1.12), suggesting Type D had no effect on these outcomes. This evidence was similar in the subset of coronary artery disease (CAD) patients, but inconclusive for heart failure (HF) patients. Positive effects were found for NA on cardiac- and all-cause mortality, the latter being more pronounced in males than females. Conclusion: Across 19 prospective cohort studies, Type D predicts adverse events in CAD patients, while evidence in HF patients was inconclusive. In both CAD and HF patients, we found evidence for a null effect of Type D on cardiac- and all-cause mortality.