Negative affectivity, social inhibition, and risk of major adverse cardiac events: An integrative data analysis

BACKGROUND: Prior research suggests that the personality traits negative affectivity (NA) and social inhibition (SI) are synergistically related to an increased risk of adverse events in patients with cardiovascular disease (CVD). Both traits-as measured by the DS14 questionnaire-are multidimensional, each comprising three facets. It remains unclear whether all facets of NA and SI contribute equally to the risk of major adverse cardiac events (MACE), or whether certain facets play a greater role. Here, we answer this question using individual patient data from four prospective studies. METHODS: The combined dataset included 1750 patients with CVD, measuring age, sex, NA and SI facets, and the occurrence of MACE during follow-up. Multilevel logistic regression models estimated synergistic interactions between NA and SI facet pairs on MACE. FINDINGS: After controlling for age and sex, the NA facet anxious apprehension synergistically interacted with the SI facets reticence (OR = 1.18 [1.05, 1.32]) and lack of social poise (OR = 1.17 [1.04, 1.32]). Higher scores on the NA facets dysphoria (OR = 1.33, [1.16, 1.52]) and irritability (OR = 1.25 [1.09, 1.42]) were associated with increased odds of MACE, independent of SI facets. No evidence was found that SI facets were independently related to MACE. CONCLUSIONS: Specific combinations of NA and SI facets synergistically increased the risk of MACE in patients with CVD. The synergy primarily reflects a personality profile combining excessive worrying with having difficulty in making contact with others and keeping others at a distance. Dysphoric and irritable patients showed elevated MACE risk regardless of their social inhibition.