PERSONALITY TYPE D AND THE LEVEL OF SUBCLINICAL INFLAMMATION MARKERS IN CHD PATIENTS

Aim. To study the level of biomarkers of subclinical inflammation in CHD patients with existence of absence of personality type D.

Material and methods. In 62 patients with stable CHD before planned CBG operation we assessed concentrations: of matrix metalloproteases -2, -3, -9, tissue inhibitor of matrix proteases -1, -2, C-reactive protein, soluble CD40 ligand, tumor necrosis factor alpha. For further study we selected two groups: 1 group (n=27) — patients with type D and 2 group (n=35) — with non-D type. Personality type was defined with DS-14 questionnaire. Patients were asked 14 questions with 5 variants of responses to each. Counting of points was done by two scales: negative irritability and social suppression. Type D was set if 10 points and more by each of the scales. All patients underwent: general and biochemical blood tests, echocardiography, color duplex scanning of brachiocephalic arteries and coronary angiography.

Results. In intergroup comparison both groups were comparable by the most anamnestic and clinical parameters. There were no any differences in the instrumental assessments data. In type D patients there was higher level of MMP-9 (resp. 53,2 pg/mL and 66,5 pg/mL; р=0,051) and sCD40L (resp. 2,8 ng/mL and 5,7 ng/mL; р=0,013) comparing with those non-D-type. The level of other biomarkers in groups did not differ, concentration of MMP-2 and TNF-α were slightly higher among type-D, of the others — among non-D-typers. There were also statistically significant negative correlations of type-D and MMP-9 and sCD40L.

Conclusion. In CHD patients, examined before coronary bypass operation, presence of type D personality was not followed by the increase of subclinical inflammation markers level comparing to patients without such type. In type-D patients there was increase of platelet activation markers activation, that associates with adverse outcomes in CHD.

1. Pedersen SS, Kupper N, Denollet J. Psychological impact and heart disease. In The ESC Textbook of Cardiovascular Medicine Second Edition. Edited by A.J. Camm, T.F. Lüscher, and P.W. Serruys, trans. from English ed. by E.V. Shljahto. M: «GJeOTAR-Media» 2011; 1332-52. (Pedersen S.S., Kupper N., Denollet J. Психологические факторы и заболевания сердца. В кн. Болезни сердца и сосудов. Руководство Европейского общества кардиологов; под ред. А.Дж. Кэмма, Т.Ф. Люшера, П.В.Серруиса, пер. с англ. под ред Е.В. Шляхто. М: «ГЭОТАР-Медиа» 2011; 1332-52).

2. Sumin AN, Rayh OI, Gayfulin RA, et al. Type D personality and quality of life one year after coronary artery bypass surgery. Ross J Cardiol. 2014; 4(108): 92-9. (Сумин А.Н., Райх О.И., Гайфулин Р.А. и др. Тип личности Д и качество жизни больных через год после операции коронарного шунтирования. Российский кардиологический журнал. 2014. 4(108): 92-9).

3. Wu JR, Moser DK. Type D personality predicts poor medication adherence in patients with heart failure in the USA. Int J Behav Med. 2014 Oct; 21(5): 833-42.

4. Grande G, Romppel M, Vesper JM, et al. Type D personality and all-cause mortality in cardiac patients--data from a German cohort study. Psychosom Med. 2011 Sep; 73(7): 548-56.

5. Denollet J, Tekle FB, van der Voort PH, et al. Age-related differences in the effect of psychological distress on mortality: Type D personality in younger versus older patients with cardiac arrhythmias. Biomed Res Int. 2013;2013:246035. doi: 10.1155/2013/246035.

6. Conraads VM, Denollet J, De Clerck LS, et al. Type D personality is associated with increased levels of tumour necrosis factor (TNF)-alpha and TNF-alpha receptors in chronic heart failure. Int J Cardiol. 2006 Oct 26; 113(1): 34-8.

7. Denollet J, Schiffer AA, Kwaijtaal M, et al. Usefulness of type D personality and kidney dysfunction as predictors of interpatient variability in inflammatory activation in chronic heart failure. Am J Cardiol. 2009 Feb 1; 103(3): 399-404.

8. Dekker RL, Moser DK, Tovar EG, et al. Depressive symptoms and inflammatory biomarkers in patients with heart failure. Eur J Cardiovasc Nurs. 2014 Oct; 13(5): 444-50.

9. Duivis HE, de Jonge P, Penninx BW, et al. Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the heart and soul study. Am J Psychiatry. 2011 Sep; 168(9): 913-20.

10. Barbarash OL, Zyikov MV, Kashtalap VV, et al. Assessment of inflammatory factors in patients with myocardial infarction with ST-segment elevation and the presence of multifocal atherosclerosis. Kardiologiya i serdechno-sosudistaya hirurgiya 2010: 3(6): 20-6. (Барбараш О.Л., Зыков М.В., Кашталап В.В. и др. Оценка факторов воспаления у больных инфарктом миокарда с подъемом сегмента ST и наличием мультифокального атеросклероза. Кардиология и сердечно-сосудистая хирургия. 2010. 3(6): 20-6).

11. Barbarash OL, Osokina AV, Karetnikova VN, et al. Role SD40- ligand in predicting cardiovascular events in patients with myocardial infarction with ST segment elevation and diabetes. Tsitokinyi i vospalenie 2010; 9(3): 25-9. (Барбараш О.Л., Осокина А.В., Каретникова В.Н. и др. Роль CD40-лиганда в прогнозировании сердечно-сосудистых осложнений у больных инфарктом миокарда с подъемом сегмента ST и сахарнымдиабетом. Цитокины и воспаление. 2010; 9(3) 25-9).

12. Pusuroglu H, Akgul O, Erturk M, et al. Predictive value of elevated soluble CD40 ligand in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Coron Artery Dis. 2014 Jul 7. [Epub ahead of print].

13. Kaptoge S, Seshasai SR, Gao P, et al. Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta-analysis. Eur Heart J. 2014 Mar; 35(9): 578-89.

14. Rondina MT, Lappé JM, Carlquist JF, et al. Soluble CD40 ligand as a predictor of coronary artery disease and long-term clinical outcomes in stable patients undergoing coronary angiography. Cardiology. 2008; 109(3): 196-201.

15. Ragino YuI, Chernyavskiy AM, Tsyimbal SYu, et al. Communication levels of inflammatory and destructive of biomaterials in blood in coronary atherosclerosis with long-term results of surgical myocardial revascularization. Byulleten eksperimentalnoy biologii i meditsinyi 2013; 155(3): 289-92. (Рагино Ю.И., Чернявский А.М., Цымбал С.Ю. и др. Связь уровней воспалительно-деструктивных биомаркеров в крови при коронарном атеросклерозе с отдаленными результатами хирургической реваскуляризации миокарда. Бюллетень экспериментальной биологии и медицины. 2013; 155(3): 289-92).