Key result
Type D personality was an independent predictor of 2-year major adverse cardiac events (OR 2.42) and increased coronary plaque vulnerability in patients with coronary artery disease.
Why the study?
Cardiovascular events and coronary plaque vulnerability are linked to Type D personality, but the underlying mechanisms remain unclear.
Does Type D personality increase plaque vulnerability and MACE in patients with CAD, and is this mediated by inflammation and kynurenine/tryptophan metabolism?
Cohort (n=177)
No
Does Type D personality increase plaque vulnerability and MACE in patients with CAD, and is this mediated by inflammation and kynurenine/tryptophan metabolism?
Odds Ratio: 2.42 (95% CI 1.04–5.6)
Absolute Event Rate: 38.6% vs 13.1%
p-value: p=0.038
Type D personality is associated with increased plaque vulnerability and adverse cardiovascular events in CAD patients, potentially mediated by systemic inflammation and altered tryptophan metabolism.
May link Type D personality to CAD plaque vulnerability via inflammation and kynurenine pathway; hypothesis-generating, needs prospective validation before practice change.
Purpose Cardiovascular events and coronary plaque vulnerability are linked to Type D personality. However, the fundamental mechanism has not been clarified. Our study determined to illustrate whether inflammatory status in plasma, in combination with kynurenine pathway activity in Type D individuals, is associated with plaque vulnerability and cardiovascular events in patients with coronary artery disease (CAD). Materials and methods The Type D personality of 177 CAD patients were evaluated. Plasma biomarkers of inflammation (TNF-α, IL-6, and hs-CRP) were measured and pooled into standardized sumscores. Tryptophan and kynurenine metabolites were measured, and the kynurenine/tryptophan ratio (KTR) was calculated. Plaque vulnerability was measured in vivo by optical coherence tomography. All patients had a follow up of 2 years in which cardiovascular adverse events were recorded. Results Type D individuals exhibited elevated TNF-α ( p = 0.007), IL-6 ( p = 0.049), inflammation sumscores ( p = 0.002), kynurenine ( p = 0.008), and KTR ( p = 0.005) than non-Type D group. The serial-multiple mediation showed that the Type D personality with a direct, favorable impact on plaque vulnerability, including thin cap fibroatheroma (TCFA) (point estimate = 0.81; 95% CI = 0.09–1.53), macrophages (point estimate = 0.79; 95% CI = 0.05–1.51), and major adverse cardiac events (MACE) (point estimate = 0.88, 95% CI = 0.08–1.70). In addition, the standardized inflammation sumscores and KTR were mediators of the Type D personality associations with TCFA, macrophages and MACE. Conclusion These results demonstrated that the connection between Type D personality and poor cardiovascular outcomes in CAD patients can be mediated by pro-inflammatory biomarkers and KTR.
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Wang et al. (2022) conducted a cohort in Coronary artery disease (n=177). Type D personality vs. Non-Type D personality was evaluated on Major adverse cardiac events (MACE) at 2 years (OR 2.42, 95% CI 1.04-5.60, p=0.038). Type D personality was an independent predictor of 2-year major adverse cardiac events (OR 2.42) and increased coronary plaque vulnerability in patients with coronary artery disease.
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