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A Pilot Study

Annelies E. Aquarius, PhD; Kim G. Smolderen, MSc; Jaap F. Hamming, MD, PhD; Jolanda De Vries, PhD; Patrick W. Vriens, MD, PhD; Johan Denollet, PhD

Arch Surg. 2009;144(8):728-733.

Background  Type D personality refers to the tendency to experience negative emotions and to inhibit self-expression in social interaction and has been shown to be an independent predictor of mortality in cardiac disease. Information about the effects of psychological traits on prognosis is lacking in cases of peripheral arterial disease (PAD).

Objective  To examine whether type D personality predicts all-cause mortality in PAD.

Design  Pilot follow-up study.

Setting  Vascular surgery department of a teaching hospital.

Patients  A total of 184 patients with symptomatic PAD (mean [SD] age, 64.8 [9.8] years) were followed up for 4 years (interquartile range, 3.5-4.5 years).

Main Outcome Measures  Patients completed the type D Scale-14 measure of type D personality at baseline. Information about all-cause mortality was obtained from patient medical files.

Results  During 4-year follow-up, 16 patients (8.7%) died. Adjusting for age and sex, type D personality was predictive of mortality (P = .03). Ankle-brachial index (P = .05), age (P = .009), diabetes mellitus (P = .02), pulmonary disease (P = .09), and renal disease (P = .02) were also predictive of mortality. Multivariable logistic regression revealed that age, diabetes, and renal disease were independent predictors of all-cause mortality (odds ratios, 1.1-2.3). After adjustment for these clinical predictors, patients with type D personality still had a more than 3-fold increased risk of death (odds ratio, 3.5; 95% confidence interval, 1.1-11.1; P = .04).

Conclusions  Type D personality predicts an increased risk of all-cause mortality in PAD, above and beyond traditional risk factors. Further research is needed to confirm these findings, but this pilot study suggests that the assessment of type D personality may be useful for detecting high-risk patients with PAD.

Author Affiliations: Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg (Drs Aquarius, De Vries, and Denollet and Ms Smolderen); Departments of Medical Psychology (Drs Aquarius and De Vries) and Surgery (Dr Vriens), St Elisabeth Hospital, Tilburg; and Department of Surgery, Leiden University Medical Center, Leiden (Dr Hamming), the Netherlands.

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