Is there a relationship between type D personality and cardiovascular disease? A comprehensive literature review

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    Marzieh Azizi 1, Forouzan Elyasi *2

    1 Ph.D. Student of Reproductive Health, Department of Midwifery and Reproductive health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Email:

    *2 Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.  E mail:

    Introduction and aim: Psychological distress has been associated with the pathogenesis and progression of cardiovascular diseases (CVDs). Among the several psychological factors, personality traits of an individual have been explored as an important factor influencing the morbidity and mortality of CVDs. Type D personality, known as distressed personality type, comprised of two main characteristics such as negative affectivity and social inhibition.  Studies found that during a period of 6–10 years, the mortality rate among type D patients with cardiovascular diseases was 27%; compared with 7% among healthy subjects. This study aimed to investigate the relation between type D personality and cardiovascular disease according to the literature review.

    Methods: In this review study, researchers conducted their comprehensive computer search in databases such as Google Scholar and more specifically PubMed, PsycINFO, ProQuest, web of science, Cochrane Library, Science Direct and Scopus in the period of 1 August 2020 until 20 August 2020. The keywords which selected by MeSH strategy were [(“Type D personality” OR “Type D personality traits”) AND (“cardiovascular diseases” OR” coronary heart disease” hypertensive disorders”)]. Articles from “1992 to 2020” were selected. Overall 28 articles have been searched. Researchers reviewed the abstract and full text of all searched articles and ultimately they applied 21 articles to write this review.

    Results: The prevalence of type D personality among patients with CHD was reported 18.7 %. Personality  traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of CVDs. Studies have found strong association between Type D personality and stress cardiomyopathy after acute emotional stressful triggers leading to acute cardiac events. Individual risk factors such as tendency to unhealthy life style, non-completion of cardiac rehabilitation programs and poor compliance to treatment in individuals with Type D personality has also been found to be associated with the risk of developing serious illness such as CVDs, premature mortality and affect the quality of life in those individuals with chronic medical illness. Psychological issues such as chronic negative affect, low self-esteem, generally dissatisfied with life, suffer from depressive symptoms, chronic tension, anger, pessimism, decreased cognitive functioning, poor social support, and low levels of perceived well-being in individuals with a Type D personality are associated with exacerbating the prognosis of CVDs. Studies have reported that those with type D personality with CVDs experience more cardiac symptoms but are less likely to report cardiac symptoms (such as swollen legs, shortness of breath, etc.) to the medical professionals and tend to seek health care lately which resulting in severe symptoms due to their social inhibition tendency.

    Conclusion: Increasing general public awareness about the role of personality traits and its impact on cardiac illness could be beneficial and various programs for psychological intervention are required to control for the distressed personality of patients with CVDs or hypertensive disorders. 

    Keywords: Type D personality, personality traits, cardiovascular diseases, coronary heart disease,

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