Type A Behavior Pattern is not a Predictor of Premature Mortality

Central Serous Chorioretinopathy: An Update on the Current State of Management

Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.

Sex-specific psychological risk profiles of CVD in the HUNT study: the role of neuroticism and extraversion

OBJECTIVE

The aim was to investigate psychological risk profiles of cardiovascular disease (CVD). Depression and anxiety have been linked to CVD, but research has not incorporated personality and sex-specific analyses are warranted. In this study, we examine the role of sex, neuroticism, extraversion, anxiety and depression on the risk of CVD.

METHOD

Using data from the HUNT-study and the mortality register, 32,383 (57.10% men) participants were followed for an average of 10.48 years. During this time, 142 died of myocardial infarction (MI) and 111 of stroke.

RESULTS

Cox regression showed that depression (HR = 1.07, 95% CI = [1.00, 1.14]) and neuroticism (1.23 [1.08, 1.40]) were significantly related to an increased risk of MI. One standard unit increase in depression and neuroticism was associated with 1.22 [CI 1.01, 1.47] increase and 1.43 [CI 1.14, 0.78] increase in the risk of MI respectively. For stroke, there was no significant effect of anxiety, depression or personality. However, we found a significant interaction effect between sex and extraversion where higher extraversion was associated with greater risk of stroke for women only.

CONCLUSIONS

Both neuroticism and depression were related to MI. We observed an interaction between extraversion and sex with stroke, but the effect size was small. The role of extroversion as a risk factor for CVD remains inconclusive.

Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.

Personality Traits and Cardiotoxicity Arising From Cancer Treatments: An Hypothesized Relationship

Thanks to the evolution in medical and pharmaceutical research, to date, the number of cancer treatments is increasingly on the rise. Despite this, several side effects related to cancer treatments can exacerbate patients’ physical and psychological conditions, such as cardiotoxicity. Over the years, researchers have explored the possible relationship between psychological variables and physical diseases. Even though some authors examined the relationship between personality and specific diseases, no scientific attention has been paid to the role of personality in the development of cardiotoxicity arising from cancer treatments. Yet this is an important objective, given that determining whether personality influences cardiac toxicity of anticancer treatments could inform the processes by which stable psychological factors influence health. This contribution summarizes and analyzes the available scientific evidence about the association between personality and main cardiotoxicity-related-diseases of anticancer therapies, including cancer and cardiovascular diseases, in order to sketch a hypothetical model of the relationship between personality traits and cardiotoxicity.

Physical Aggression and Coronary Artery Calcification: A North Texas Healthy Heart Study

BACKGROUND

The purpose of this study was to determine the association between aspects of hostility and coronary artery calcification (CAC) scores. Specifically, analyses differentiated between subtypes of hostility and their relation to CAC.

METHODS

A sample of 571 patients aged 45 or older with no history of cardiovascular disease completed assessments of demographic, psychosocial, and medical history, along with a radiological CAC determination. Logistic regression was used to determine the association between hostility and CAC. Hostility was measured using the Aggression Questionnaire, which measured total aggression and how aggression is manifested on four scales: Physical, Verbal, Anger, and Hostility Aggression.

RESULTS

Regression analyses indicated that only the physical aggression parameter was related to CAC: a 5% increase in odds of CAC presence was indicated for every point increase in physical aggression. The association remained significant in adjusted analyses. Other factors associated with CAC in adjusted analyses included: age, gender, race/ethnicity, BMI, and dyslipidemia.

CONCLUSIONS

Psychosocial factors, such as physical aggression, are emerging factors that need to be considered in cardiovascular risk stratification.

Type C Personality: Conceptual Refinement and Preliminary Operationalization

In this paper, we have presented our proposal for reconceptualization and operationalization of Type C (cancer-prone) personality. Based on theoretical analyses, taking into account both the literature on Type C and models of personality structure, we have proposed a two-facet structure of Type C, comprising Submissiveness (the interpersonal aspect) and Restricted Affectivity (the intrapersonal aspect). The study devoted to the validation of the measure of Type C involved 232 participants aged 18-70 (M = 29.35, SD = 8.93; 54% male). We used (a) our proposed measure of Type C personality and (b) the Circumplex of Personality Metatraits Questionnaire (CPM-Q-SF; Strus and Cieciuch, 2017), assessing personality metatraits. The measure of Type C proved to have acceptable internal consistency (Cronbach's alpha was 0.85 for Submissiveness and 0.78 for Restricted Affectivity). The measurement model in confirmatory factor analysis with two latent variables proved to be well-fitted to the data. We have also confirmed the hypothesis concerning the location of the two facets of Type C personality close to each other in the theoretically predicted area between the Delta-Plus/Self-Restraint and Beta-Minus/Passiveness metatraits (in the Circumplex of Personality Metatraits). The clinical value of the theoretically refined Type C can be tested in the next step in research on patients with cancer.

Sex- and Gender-Stratified Risks of Psychological Factors for Incident Ischemic Heart Disease: Systematic Review and Meta-Analysis

Background

Psychological factors are associated with an increased risk of developing ischemic heart disease (IHD). Women more often report psychological factors, and sex and gender differences are present in IHD. In this meta‐analysis we examine the risks of psychological factors for IHD incidence in women and men. We hypothesize that a broad range of psychological factors are related to a higher risk for incident IHD, with a higher risk for women.

Methods and Results

PubMed, EMBASE, and PsycINFO were searched for studies assessing the risk between psychological factors and incident IHD. Psychological factors included depression, anxiety or panic disorder, social support, hostility, anger, personality (type D), type A behavior pattern, posttraumatic stress disorder, and psychological distress. In the primary analyses, 62 studies (77 separate reports) that included 2 145 679 women and 3 119 879 men and reported confounder‐adjusted hazard ratios or relative risks were included. Pooled effect confounder‐adjusted estimates from random‐effects models showed that psychological factors (all combined) were associated with incident IHD in women (hazard ratio: 1.22; 95% CI, 1.14–1.30) and men (hazard ratio: 1.25; 95% CI, 1.19–1.31). No sex and gender differences were found for these pooled effect estimates (P=0.547).

Conclusions

Psychological factors are associated with incident IHD in both women and men, but no significant differences were observed between women and men. IHD is predominantly being studied as obstructive coronary artery disease, which is more prevalent in men. Data are needed on psychological predictors and other manifestations of IHD such as coronary microvascular disease, which is more common in women.

Personality types in individuals with type 1 and type 2 diabetes

OBJECTIVE

The Type A personality, characterized by impatience, strong career ambition and competitiveness, is associated with greater sensitivity to external stress. Type 1 diabetes (T1D) is an auto-immune disease, which is potentially influenced by stress, unlike type 2 diabetes (T2D). The aim of this study was to assess whether individuals with T1D and T2D exhibited significant differences on the Type A personality scale. We also assessed the personality in patients with thyroid auto-immune diseases to validate potential links between auto-immune disease and Type A.

DESIGN AND METHODS

The Bortner questionnaire was used to assess Type A personality in 188 patients with T1D, 430 patients with T2D and 85 patients with auto-immune thyroid disease (Graves' disease or Hashimoto thyroiditis).

RESULTS

Type A Bortner scores were significantly higher in T1D patients than in T2D patients (188±34 vs 177±36, p<0.0001). Patients with auto-immune thyroid diseases and T1D patients had similar Type A Bortner scores (189±33 vs 188±34, p=0.860).

CONCLUSION

Patients with auto-immune T1D have higher Type A scores than T2D patients. Furthermore, patients with auto-immune thyroid disease also have elevated Type A scores similar to those observed in type 1 diabetes, suggesting that an elevated Type A score in T1D is potentially related to its autoimmune origin. This suggests a possible link between Type A personality and auto-immune diseases via stress-triggering psychobiological pathways. The different personality score between T1D and T2D is an important factor to consider that could influence the diabetes self-care coping strategies and long-term prognosis.

Perception vs pain and beliefs about pain control and Type A behavior pattern in patients with chronic ischemia of lower extremities or with rheumatoid arthritis

Objective

The study aimed at determining the experience of pain taking into consideration beliefs about pain control, Type A behavior pattern and sociodemographic factors in patients with chronic ischemia of the lower extremities or with rheumatoid arthritis (RA).

Methods

The study enrolled 100 patients with peripheral arterial disease (PAD) and 100 patients with RA. The subjective sensation of pain was assessed using the Visual Analog Scale (VAS); beliefs about pain control were analyzed using the Beliefs about Pain Control Questionnaire (BPCQ), taking into consideration internal factors, the influence of physicians and accidental events (chance); and Type A behavior features (haste and competition) were analyzed using the Framingham Type A Scale. The multiple regression model was used to assess associations between the experienced pain and the BPCQ value, the Framingham Type A Scale and sociodemographic factors.

Results

The pain intensity degree was found to be comparable in patients with PAD and with RA. The median determined using the VAS was 5.75 in both of the studied groups. In patients with PAD, lower VAS values were associated with the BPCQ – internal factors (P<0.05) whereas a higher VAS value was related to the BPCQ – physicians’ influence (P<0.001). In patients with RA, a higher VAS value was associated with BPCQ – physicians’ influence (P<0.05), disease duration (P<0.05) and smoking cigarettes (P<0.05).

Conclusion

Experiencing pain by patients with chronic ischemia of the lower extremities occurs at a moderate level and is beneficially connected with the internal factors and adversely connected with the external factors of beliefs about pain control. Patients with RA reported pain ailments of a moderate level in connection with the adverse influence of the external factors of beliefs about pain control, the duration of the disease and smoking cigarettes. Experiencing pain by patients with chronic ischemia of the lower extremities and RA does not seem to be related to Type A behavior.

Type A competitiveness traits correlate with downregulation of c-Fos expression in patients with type 1 diabetes

AIM

Type A personality has been associated with increased survival in people with type 1 diabetes (T1D). Systemic low-grade inflammation may play a critical role, as suggested in recent reports, although the links between the inflammatory circulating transcriptome and Type A remain unknown. This prompted our exploration of the potential associations between Type A personality and c-Fos gene expression, a candidate gene closely linked to inflammatory processes, in T1D.

METHODS

Type A personality was assessed by Bortner questionnaire in patients with T1D, and two subscales - 'speed' and 'competitiveness' - were used to measure these specific dimensions of Type A. Expression of the c-Fos gene was assessed by a quantitative real-time polymerase chain reaction technique.

RESULTS

This pilot study included 20 men with T1D. Multivariable analyses showed an independent inverse association between Type A competitiveness score and c-Fos expression, while a regression model adjusted for age, body mass index and HbA_1c levels revealed a significant inverse relationship between c-Fos transcripts and Type A competitiveness (P = 0.003).

CONCLUSION

This strong association between Type A competitiveness and reduced c-Fos expression is in line with recent data suggesting a psychobiological influence of the Type A profile in T1D via inflammatory pathways.

Associations between Hunter Type A/B Personality and Cardiovascular Risk Factors from Adolescence through Young Adulthood

PURPOSE

Type A personality, characterized by action-oriented tendencies, has been linked to cardiovascular disease in middle-aged and elderly adults. Alternatively, limited research has tested whether personality type A/B and cardiovascular (CVD) risk are linked prior to adulthood. Therefore, we used the Hunter-Wolf A/B personality score to determine whether personality type A/B is associated with traditional CVD risk factors during adolescence, and more importantly if personality type, or its individual type A components, are associated with cardiovascular risk through young adulthood. This study is the first to assess personality type A/B on a continuous spectrum with regard to its relationship with cardiovascular disease risk, as well as the first to examine this association in a biracial, adolescent population.

METHODS

Subjects (3396) from the Bogalusa Heart Study were surveyed from 1984 to 1986, and multivariable regression was used to test adjusted, cross-sectional associations between personality type A/B, as determined by Hunter-Wolf A/B personality questionnaire, and CVD risk factors during adolescence. To test whether associations existed longitudinally, subjects were followed through 2007, and general estimating equation (GEE) models were used to examine the associations of personality type A/B with CVD risk factors, as well as with Framingham risk score as a global score of CVD risk. The component traits of type A personality (leadership, hard-driving, eagerness-energy, and impatience-aggression) were tested individually to determine their independent, longitudinal associations with global CVD risk.

RESULTS

Baseline mean (SD) age was 15.9(5.2). Mean( SD) Hunter-Wolf score in was 96.9 (11.6). After adjustment, more type A Hunter-Wolf scores were cross-sectionally associated with lower alcohol consumption (p = 0.03), female gender (p < 0.0001), and black race (p < 0.0001) in adolescence. After follow-up (median = 11 years), personality type A/B as the continuous Hunter-Wolf score was non-linearly associated with young adult BMI (p = 0.01), fasting blood glucose (p < 0.01), and Framingham score (p = 0.05). Of the type A components, leadership and hard-driving were non-linearly associated with Framingham risk at follow-up (both p < 0.0001).

CONCLUSIONS

Adolescent personality type A is associated with female gender and black race. Generally, type A children have higher CVD risk during young adulthood, though this relationship is non-linear. Additionally, adolescents exhibiting strong leadership-oriented personality traits have worse cardiovascular risk profiles in early adulthood, whereas hard-driving adolescent personalities are protective of young adult CVD risk. Our results warrant consideration of personality as a continuous, non-categorical, trait in studies of cardiovascular disease.

Type D personality, but not Type A behavior pattern, is associated with coronary plaque vulnerability

Personality traits are associated with major adverse coronary events (MACE) in patients with coronary artery disease (CAD). However, the link between personality traits and intravascular morphology in CAD patients is poorly understood. This study investigated the relationship between personality traits, specifically Type A behavior pattern and Type D personality, and plaque vulnerability. After adjustment for demographic and clinical factors, multivariable regression analysis showed no association between Type A and optical coherence tomography indices. However, Type D personality was independently associated with lipid plaque, thin cap fibroatheroma (TCFA), and fibrous cap thickness. More specifically, negative affectivity of Type D was related to lipid plaque, TCFA and fibrous cap thickness, and social inhibition was associated with plaque rupture. Our results show that Type D personality was associated with plaque vulnerability, independent of clinical factors. Measurement of negative affectivity and social inhibition will increase our understanding of the progressive phase of the plaque vulnerability, which can contribute to the early identification of high risk patients and reduce the incidence of MACE.

Associations between Hunter Type A/B Personality and Cardiovascular Risk Factors from Adolescence through Young Adulthood

PURPOSE

Type A personality, characterized by action-oriented tendencies, has been linked to cardiovascular disease in middle-aged and elderly adults. Alternatively, limited research has tested whether personality type A/B and cardiovascular (CVD) risk are linked prior to adulthood. Therefore, we used the Hunter-Wolf A/B personality score to determine whether personality type A/B is associated with traditional CVD risk factors during adolescence, and more importantly if personality type, or its individual type A components, are associated with cardiovascular risk through young adulthood. This study is the first to assess personality type A/B on a continuous spectrum with regard to its relationship with cardiovascular disease risk, as well as the first to examine this association in a biracial, adolescent population.

METHODS

Subjects (3396) from the Bogalusa Heart Study were surveyed from 1984 to 1986, and multivariable regression was used to test adjusted, cross-sectional associations between personality type A/B, as determined by Hunter-Wolf A/B personality questionnaire, and CVD risk factors during adolescence. To test whether associations existed longitudinally, subjects were followed through 2007, and general estimating equation (GEE) models were used to examine the associations of personality type A/B with CVD risk factors, as well as with Framingham risk score as a global score of CVD risk. The component traits of type A personality (leadership, hard-driving, eagerness-energy, and impatience-aggression) were tested individually to determine their independent, longitudinal associations with global CVD risk.

RESULTS

Baseline mean (SD) age was 15.9(5.2). Mean( SD) Hunter-Wolf score in was 96.9 (11.6). After adjustment, more type A Hunter-Wolf scores were cross-sectionally associated with lower alcohol consumption (p = 0.03), female gender (p < 0.0001), and black race (p < 0.0001) in adolescence. After follow-up (median = 11 years), personality type A/B as the continuous Hunter-Wolf score was non-linearly associated with young adult BMI (p = 0.01), fasting blood glucose (p < 0.01), and Framingham score (p = 0.05). Of the type A components, leadership and hard-driving were non-linearly associated with Framingham risk at follow-up (both p < 0.0001).

CONCLUSIONS

Adolescent personality type A is associated with female gender and black race. Generally, type A children have higher CVD risk during young adulthood, though this relationship is non-linear. Additionally, adolescents exhibiting strong leadership-oriented personality traits have worse cardiovascular risk profiles in early adulthood, whereas hard-driving adolescent personalities are protective of young adult CVD risk. Our results warrant consideration of personality as a continuous, non-categorical, trait in studies of cardiovascular disease.

Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation

Cardiovascular events and emotional disorders share a common epidemiology, thus suggesting fundamental pathways linking these different diseases. Growing evidence in the literature highlights the influence of psychological determinants in somatic diseases. A patient's socio-economic aspects, personality traits, health behavior and even biological pathways may contribute to the course of cardiovascular disease. Cardiac events often occur suddenly and the episode can be traumatic for people not prepared for such an event. In this review of the literature, the authors tackle the question of psychobiological mechanisms of stress, in a pathophysiological approach to fundamental pathways linking the brain to the heart. Various psychological, biological and genetic arguments are presented in support of the hypothesis that various etiological mechanisms may be involved. The authors finally deal with biological and psychological strategies in a context of cardiovascular disease. Indeed, in this context, cardiac rehabilitation, with its global approach, seems to be a good time to diagnose emotional disorders like anxiety and depression, and to help people to cope with stressful events. In this field, cardiac rehabilitation seems to be a crucial step in order to improve patients' outcomes, by helping them to understand the influence of psychobiological risk factors, and to build strategies in order to manage daily stress.