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Coronary heart disease is a global pandemic. It is caused by the narrowing of the arteries that supply blood to the heart. When these arteries are occluded, it will result in dangerous conditions such as acute chest pain (unstable angina) and heart attack (myocardial infarction). In Hong Kong, coronary heart disease is one of the leading causes of hospital admission, with the crude death rate reported as 70 for male and 55.5 for female per 100,000 population of respective sex in 2007. Management of coronary heart disease relies on effective medical treatment, stenting procedure of the diseased vessel by catheter approach, as well as identification and control of the risk factors.

Whereas there is an increased public awareness on the lifestyle-related risk factors to this disease, little attention has been paid to the role of personality on the disease progression. Recently, a new personality trait has been introduced, called “Type D personality”. The “D” stands for “distressed”. Type D personality refers to a trait characterized by two typical features: i) the tendency to experience negative affections such as worries, irritability and gloom (Negative Affectivity), and ii) the tendency to inhibit self-expression in social interaction with a lack of self-assurance (Social Inhibition). People with this personality trait tend to be more hostile, anxious and have a negative view. They also tend to overreact to stressful circumstances and feel insecure and uncomfortable in group settings. In the Western population, the prevalence of Type D personality among patients with coronary heart disease varies from 18% to 53%. These studies showed that Type D personality was associated with a 5-8 fold increased risk of myocardial infarction (heart attack) and a 4-fold increased risk of mortality. However, there is no such data in the Asian population.

Professor Yu Cheuk-man of Division of Cardiology, Department of Medicine & Therapeutics and Institute of Vascular Medicine at CUHK; Professor Doris Yu of The Nethersole School of Nursing at CUHK and Professor Johan Denollet of Department of Psychology and Health at Tilburg University in Belgium who developed Type D personality jointly conducted a study to determine the implications of Type D personality in patients with coronary heart disease in Hong Kong. This study was conducted in a form of a questionnaire consisting of 14 questions. The study screened a total of 326 Chinese adult patients with coronary heart disease (217 male and 109 female, with mean age at 67 years old) from November 2006 to January 2008. Results showed that 31% of patients have Type D personality.

We also found that Type D personality exhibited adverse psychosocial risk factors which may accelerate coronary heart disease. Among patients with Type D personality, 13% had clinical anxiety and 43% had clinical depression, which is dramatically more common than those without Type D personality that only affected 1.4% and 17% of patients respectively. Furthermore, patients with Type D personality possessed more neurotic behaviors and reported more stress-related symptoms such as insomnia, epigastric pain, back pain and headache. They also exhibited more social alienation in interacting with others. It is postulated that Type D personality adversely affects the neurohormonal and immune systems, and thus worsens coronary heart disease.

In conclusion, Type D personality is prevalent in Chinese patients with coronary heart disease. We recommend health care professionals to adopt screening assessment of Type D personality in patients with coronary heart disease. For such patients, specific treatment approaches such as cognitive-behavioral therapy, interpersonal psychotherapy and social skill training should be considered to better control the common psychosocial risk factors of coronary heart disease.