شخصیت نوع D و دوره وضعیت سلامتی بیش از 18 ماه در بیماران سرپایی مبتلا به نارسایی قلبی: چند واسطه بیومارکرهای التهابی

Background The distressed (Type D) personality is associated with poor health status (HS) and increased inflammatory activation in heart failure (HF). We tested whether multiple inflammatory biomarkers mediated the association between Type D personality and the course of self-reported HS over 18 months. Methods HF outpatients (n = 228, 80% male, mean age 67.0 ± 8.7 years), filled out the Type D questionnaire (DS14) at inclusion and the Short Form-12 (SF12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 0, 6, 12, and 18 months. Blood samples at inclusion were analyzed for high sensitive C-reactive protein (hsCRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and its soluble receptors (sTNFr1, sTNFr2). A multiple mediation latent growth model was tested using structural equation modeling. Results Type D personality (prevalence = 21%) was associated with poorer HS (all scales p < 0.001), deterioration of mental HS (p < 0.001), and higher TNF-α and sTNFr2 levels in the full mediation model. A higher inflammatory burden was associated with a poorer baseline level and a deterioration of generic physical, mental and disease-specific HS. No mediating effects were found for the multiple inflammatory biomarkers on the association between Type D and baseline self-reported HS, whereas change in physical HS was significantly mediated by the group of five inflammatory biomarkers (p = 0.026). Conclusions Only the association between Type D personality and change in self-reported physical health status was significantly mediated by inflammatory biomarkers. Future research should investigate whether the association between Type D personality and poor health status may be explained by other biological or behavioral factors. Highlights

Heart failure (HF) is a taxing condition, with frequent hospitalizations (Jhund et al., 2009), increased mortality (Curtis et al., 2008), and impaired health status (Juenger et al., 2002). Its prevalence continues to increase as a consequence of the aging population and improved survival after cardiac events (Murdoch et al., 1998 and Senni et al., 2005). Ample studies have linked psychological risk markers with health outcomes in HF, including poor health status (MacMahon and Lip, 2002 and Pelle et al., 2008). Health status is defined as a self-reported assessment of patients’ symptoms, function, and quality of life (Spertus, 2008), and poor self-reported physical health status is a predictor of adverse HF prognosis (Mommersteeg et al., 2009). One emerging psychological risk marker in this context is the ‘distressed’ (Type D) personality type. Type D personality is characterized by a general propensity to psychological distress as defined by high negative affectivity and social inhibition (Denollet, 2005 and Denollet et al., 2010), and has been consistently associated with poor health status (Pedersen et al., 2010, Pelle et al., 2009 and Schiffer et al., 2008).