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01-10-2013 | Uitgave 8/2013

Quality of Life Research 8/2013

Type D personality and patient-perceived health in nonsignificant coronary artery disease: the TWeesteden mIld STenosis (TWIST) study

Quality of Life Research > Uitgave 8/2013
Paula M. C. Mommersteeg, Irene Pot, Wilbert Aarnoudse, Johan Denollet, Jos W. Widdershoven
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s11136-012-0340-2) contains supplementary material, which is available to authorized users.



To examine whether Type D—distressed—personality is independently associated with patient reported health outcomes, such as chest pain, health status and emotional distress, in patients with angiographically nonsignificant coronary abnormalities. Psychosocial factors, such as Type D personality, are risk factors for established coronary artery disease (CAD), but are unknown for patients with non-obstructive CAD.


A total of 273 patients (62 years, SD 10, 49 % male) participated in the cross-sectional part of the ‘TWeesteden mIld STenosis’ study. Inclusion was based on coronary angiography or CT-scan. Type D personality was examined in relation to chest pain, disease-specific (Seattle Angina Questionnaire) and generic health status (Short Form 12), and emotional distress (Hospital Anxiety and Depression Scale, Fatigue), adjusted for confounders and potential explanatory lifestyle factors.


Patients with Type D personality (30 %) had an increased prevalence of chest pain (57 vs. 40 %). When adjusted for confounder’s age, gender, comorbidity, and medication use, Type D personality was significantly associated with increased chest pain, poorer disease-specific and generic health status and increased emotional distress. After further adjustment for explanatory lifestyle factors such as smoking, physical activity, and metabolic syndrome, Type D personality was associated with worse disease perception, lower treatment satisfaction, poor physical and mental health status, and higher emotional distress, but no longer with chest pain, angina stability, or physical limitations.


Type D personality was significantly associated with poor patient-perceived symptoms in patients with mild coronary abnormalities, which can be hypothesized to be detrimental in the long run.

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