Evaluation of affective temperaments and arterial stiffness in different hypertension phenotypes

The myth of a cancer-specific temperament: An analysis of affective temperament in cancer patients

OBJECTIVE

We investigate the prevalence of five affective temperaments (depressive, cyclothymic, hyperthymic, irritable, and anxious) in a large sample of cancer patients and associations of temperament with cancer site as well as the impact of temperament on overall survival of cancer patients.

METHODS

Data for this prospective cohort study was collected in the outpatient clinic of a large cancer center. We used the Temperament Evaluation in Memphis, Pisa and San Diego - Münster Version (TEMPS-M) and recorded patient data. The sample consisted of 2531 patients with seven different cancer/disease-sites. Kruskal-Wallis tests and pairwise Wilcoxon rank sum test were applied to compare temperament scales across disease groups. For analyzing survival time, we used a Cox regression model and log-rank tests.

RESULTS

The five affective temperaments were similarly distributed across all disease groups. We found higher levels of depressive, cyclothymic, and anxious temperament in women and higher levels of hyperthymic and irritable temperament in men. Temperament was mostly not predictive of survival, with only two significant results in the regression models. Here, cyclothymic temperament was predictive of mortality in the full sample and hyperthymic temperament was predictive of the pancreatic cancer subsample.

CONCLUSIONS

Our study provides evidence to debunk the myth of a cancer-specific temperament. Neither did we find a temperament profile that was different from studies with general population samples, nor were there any disease-specific profiles differentiating various types of cancer.

Association between affective temperaments and the severity and the extent of coronary artery disease as obtained by coronary CT angiography

BACKGROUND

Affective temperaments are documented predictors of psychopathology, but cumulating data suggest their relationship with coronary artery disease (CAD). We aimed to evaluate their role in relation to surrogate semiquantitative markers of coronary plaque burden, as assessed by coronary CT angiography (CCTA).

METHODS

We included 351 patients who were referred for CCTA due to suspected CAD. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). The severity and extent of CAD was evaluated by CCTA, applying semiquantitative plaque burden scores, notably Segment Involvement Score (SIS) and Segment Stenosis Score (SSS). Logistic regression analyses were performed to define the predictors of CAD severity and extent.

RESULTS

Regarding the scores evaluated by TEMPS-A that consists of 110 questions, in men, significant inverse association was found between hyperthymic temperament score and SSS (β = -0.143, (95%CI: -0.091 to -0.004), p = 0.034). Compared to the TEMPS-A form, applying the abbreviated version - containing 40 questions - significant relationship between affective temperaments and SSS or SIS was found in case of both sexes. Concerning men, hyperthymic temperament was demonstrated to be independent predictor of both SSS (β = -0.193, (95%CI: -0.224 to -0.048), p = 0.004) and SIS (β = -0.194, (95%CI: -0.202 to -0.038), p = 0.004). Additionally, we proved, that significant positive association between irritable temperament and SSS (β = 0.152, (95%CI: 0.002 to 0.269), p = 0.047) and SIS (β = 0.155, (95%CI: 0.004 to 0.221), p = 0.042) exists among women.

LIMITATIONS

Cross-sectional analysis of a single center study with self-reported questionnaires.

CONCLUSIONS

Assessment of affective temperaments could offer added value in stratifying cardiovascular risk for patients beyond traditional risk factors.

Adherence to dietary recommendations mediates the effect of affective temperaments on infertility treatment outcomes

Affective temperaments have been shown to robustly affect infertility treatment success. However, identification of possible mediating factors through which they exert their influence is still lacking. A growing number of results suggest that adherence to recommended treatments may be such a mediator, on the one hand, because affective temperaments are known to influence adherence and, on the other hand, because non-adherence negatively influences the treatment outcome. Recommended treatment of infertility involves, beyond medications, dietary and lifestyle changes. The aim of this retrospective cohort study was to evaluate whether adherence to physician-prescribed diet and physical activity recommendations mediates the effect of affective temperaments on infertility treatment outcomes. Among 308 women who underwent infertility treatment in an Assisted Reproduction Center, affective temperaments, adherence to diet, adherence to physical exercise, and infertility treatment success (clinical pregnancy) were assessed besides detailed medical history and demographic parameters. Associations between affective temperaments, adherence to diet and recommended physical activity, and assisted reproduction outcomes were analyzed using generalized linear models and causal mediation analysis. Adherence to physical activity didn't have an effect, but diet adherence increased the odds of infertility treatment success by 130% suggesting its role as a potential mediator. Based on causal mediation analysis, higher depressive and anxious temperament scores were directly associated with 63% and 45% lower odds of achieving clinical pregnancy, respectively, with effects not mediated by diet adherence. Higher irritable temperament scores indirectly decreased the odds of achieving clinical pregnancy by 14%, mediated by diet adherence; while higher cyclothymic temperament scores decreased the odds of achieving clinical pregnancy both directly by 51% and indirectly, mediated by diet adherence by 11%. Our results suggest that diet adherence mediates the mechanism by which irritable and cyclothymic affective temperaments influence IVF treatment success. Since adherence is a modifiable risk factor of infertility treatment success, screening for affective temperaments may help to identify potentially high-risk non-adherent patient groups and offer patient-tailored treatment, which may help increase the chances of a successful pregnancy and live birth in women undergoing IVF treatment.

Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions

Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35-0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4-0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31-0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.

A causal relationship between irritability and cardiovascular diseases: a Mendelian randomization study

Background

Observational studies have suggested that irritability is associated with a higher risk of cardiovascular disease (CVD). However, the potential causal association is not clear. Therefore, we used Mendelian randomization (MR) analysis to assess the causal association of irritability with CVD risk.

Methods

A two-sample MR analysis was performed to confirm the causal association of irritability with the risk of several common CVDs. The exposure data were derived from the UK biobank involving 90,282 cases and 232,386 controls, and outcome data were collected from the published genome-wide association studies (GWAS) and FinnGen database. Inverse-variance weighted (IVW), MR-Egger, and weighted median methods were performed to assess the causal association. Furthermore, the mediating effect of smoking, insomnia, and depressed affect was explored by using a two-step MR.

Results

The MR analysis indicated that genetically predicted irritability increased the risk of CVD, including coronary artery disease (CAD) (Odds ratio, OR: 2.989; 95% confidence interval, CI: 1.521-5.874, p = 0.001), myocardial infarction (MI) (OR: 2.329, 95% CI: 1.145-4.737, p = 0.020), coronary angioplasty (OR: 5.989, 95% CI: 1.696-21.153, p = 0.005), atrial fibrillation (AF) (OR: 4.646, 95% CI: 1.268-17.026, p = 0.02), hypertensive heart disease (HHD) (OR: 8.203; 95% CI: 1.614-41.698, p = 0.011), non-ischemic cardiomyopathy (NIC) (OR: 5.186; 95% CI: 1.994-13.487, p = 0.001), heart failure (HF) (OR: 2.253; 95% CI: 1.327-3.828, p = 0.003), stroke (OR: 2.334; 95% CI: 1.270-4.292, p = 0.006), ischemic stroke (IS) (OR: 2.249; 95% CI: 1.156-4.374, p = 0.017), and ischemic stroke of large-artery atherosclerosis ISla (OR: 14.326; 95% CI: 2.750-74.540, p = 0.002). The analysis also indicated that smoking, insomnia, and depressed affect play an important role in the process of irritability leading to cardiovascular disease.

Conclusion

Our findings support the first genetic evidence of the causality of genetically predicted irritability with the risk of developing into CVDs. Our results deliver a viewpoint that more early active interventions to manage an individual's anger and related unhealthy lifestyle habits are needed to prevent the occurrence of adverse cardiovascular events.

A bitter pill to swallow? Impact of affective temperaments on treatment adherence: a systematic review and meta-analysis

BACKGROUND

Predominant affective temperament may affect adherence to prescribed pharmacotherapeutic interventions, warranting systematic review and meta-analysis.

METHODS

The Scopus, Web of Science, PubMed, and OVID MedLine databases were inquired since inception up to 31st of March 2022 for records of any study design documenting quantitative evidence about affective temperaments as measured by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) questionnaire and treatment adherence measured by the means of major rating scales on the matter. People with low vs. high levels of treatment adherence, matched for otherwise clinically relevant variables, were deemed as cases and controls, respectively, using standardized mean differences (SMDs) in pertinent scores under random-effects meta-analysis.

RESULTS

Nine studies encompassing 1138 subjects pointed towards significantly higher cyclothymic (SMD = -0.872; CI: [-1.51 to -0.24]; p = 0.007), irritable (SMD = -0.773; CI: [-1.17 to -0.37]; p < 0.001) and depressive (SMD = -0.758; CI: [-1.38 to -0.14]; p = 0.017) TEMPS-A scores both for psychiatric and nonpsychiatric samples with poorer adherence.

LIMITATIONS

Intrinsic limitations of the present report include the heterogeneity of the operational definitions documented across different primary studies, which nonetheless reported on the sole medication-treatment adherence, thus limiting the generalizability of the present findings based on a handful of comparisons.

CONCLUSIONS

Though further primary studies need to systematically account for different clinical and psychosocial moderators across different clinical populations and operational definitions, cyclothymic, depressive, and irritable temperament scores may nonetheless predict treatment adherence and, thus, overall treatment outcomes.

Depression and anxiety in different hypertension phenotypes: a cross-sectional study

BACKGROUND

Hypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy controls (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT).

METHODS

In a cross-sectional study setup 363 patients were included with the following distribution: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A).

RESULTS

BDI points were higher in WhHT (7 (3-11)) and ResHT (6 (3-11.5)) compared with Cont (3 (1-6), p < 0.05). Similarly, HAM-A points were higher in WhHT (8 (5-15)) and ResHT (10.5 (5.25-18.75)) compared with Cont (4 (1-7), p < 0.05) and also compared with non-ResHT (5 (2-10), p < 0.05). ResHT was independently associated with HAM-A scale equal or above 3 points (Beta = 3.804, 95%CI 1.204-12.015). WhHT was independently associated with HAM-A scale equal or above 2 points (Beta = 7.701, 95%CI 1.165-18.973) and BDI scale equal or above 5 points (Beta = 2.888, 95%CI 1.170-7.126).

CONCLUSIONS

Our results suggest psychopathological similarities between white-coat hypertension and resistant hypertension. As recently it was demonstrated that white-coat hypertension is not a benign condition, our findings can have relevance for future interventional purposes to improve the outcome of these patients.

Comparison of Different Cardiovascular Risk Score and Pulse Wave Velocity-Based Methods for Vascular Age Calculation

BACKGROUND

The calculation of vascular age can help patients understand the importance of adherence to healthy lifestyle and medications. However, multiple methods are available to calculate vascular age and no comparison data is available yet. Our aim was to evaluate vascular age based on the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE) and carotid-femoral pulse wave velocity (PWV).

METHODS

Consecutive subjects between the age of 40-65 years, who took part in a screening program in three general practitioner practices were involved. PWV was measured by tonometry and was compared with normal values. Vascular age was defined based on FRS and SCORE according to literature data.

RESULTS

One hundred and seventy-two (172) patients were involved. The median chronological age was 55.5 (48.8-61.2) years. The median vascular age based on FRS and SCORE were 64 (54-79) years and 55 (44.2-60.7) years, respectively (p<0.05). Based on PWV, FRS and SCORE, 40.1%, 78.5% and 32% of the subjects had increased vascular age compared with chronological age, respectively (PWV+, FRS+, SCORE+, p<0.05). Fifty-eight (58) (84%) of the PWV+ subjects were also FRS+, and this proportion was high in case of SCORE+ patients as well (n=47, 85.4%). However, only moderate overlap was found between PWV+ and SCORE+ subjects as 17 (30.9%) of SCORE+ patients were also PWV+.

CONCLUSION

The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrants further detailed comparison of different vascular age calculation methods.