Worries May Worsen Peripheral Arterial Disease

Having a negative, inhibited personality may increase the risk of death among people with peripheral arterial disease (PAD), a Dutch study suggests. PAD occurs when plaque accumulates in arteries that supply blood to areas of the body other than the heart and brain. The study included 184 PAD patients, average age 64.8, in the Netherlands. They filled out a personality questionnaire designed to assess their distress, negativity and social inhibition. During four years of follow-up, 16 patients (8.7 percent) died. After adjusting for other factors, the researchers concluded that PAD patients with a distressed personality had a higher risk of death. "Preliminary evidence suggests that personality traits such as hostility may also be associated with the severity and progression of atherosclerosis [plaque buildup] in patients with PAD," wrote Annelies E. Aquarius, of Tilburg University, and colleagues. "Another potential individual risk factor in this context is the distressed personality type [type D]. Type D refers to the joint tendency to experience negative emotions and to inhibit self-expression in social interaction." The researchers said type D personality is associated with increased activation of the immune system and changes in the body's stress response system. "Inadequate self-management of chronic disease is a potential behavioral mechanism that may explain the relation between type D personality and poor prognosis in cardiovascular disease," they noted. Although patients with peripheral arterial disease often have multiple risk factors for cardiovascular events, the authors said these patients receive "suboptimal" secondary prevention. "In addition to improving awareness of the traditional medical risk factors in peripheral arterial disease, attention should be given to psychological factors that may have an adverse effect on the clinical course of peripheral arterial disease. The present findings show that screening for type D personality may be especially important in this context," they concluded.