The interplay of psychosocial and neurological disorders with cardiovascular risk

This issue of the European Journal of Preventive Cardiology explores the evolving landscape of cardiovascular risk by integrating psychosocial, neurological, metabolic, and emerging factors. Type D personality, characterized by negative affectivity and social inhibition, is associated with an increased risk of major adverse cardiovascular events (MACE) and is considered a cardiovascular risk factor. Despite the strong concordance of cardiovascular risk factors between couples, it remains unclear whether the Type D personality of one partner affects the cardiovascular risk of the other. In ‘Type D personality as a risk factor for 3-year cardiovascular events in patients with coronary artery disease and their spouse: a prospective cohort study’, Wang et al.1 from China prospectively followed up 4271 patients with coronary artery disease (CAD) undergoing their first coronary intervention and their spouses during 2017–20. After completing the Type D Scale-14 questionnaire at enrolment, 871 CAD patients and 234 spouses developed MACE [a composite of cardiac hospitalization, acute myocardial infarction (AMI), coronary revascularization, and cardiac death] over three years. Compared with the Type D(−) patient/Type D(−) spouse group as the reference, both patients and spouses were more likely to develop MACE if either partner was Type D(+). In the Type D(+) patient/Type D(+) spouse group, patients and spouses were 3.8 and 2.7 times more likely to develop MACE, respectively. Additionally, a synergistic interaction between the negative affectivity of the patient and the spouse was associated with a higher risk of MACE in both CAD patients and spouses. In the accompanying editorial, Albus2 puts these findings into clinical perspective, advocating for the assessment of psychosocial risk factors on an individual level while also exploring the role of couple-centred interventions in improving outcomes for patients with CAD and Type D personality.