Features August 2011 Issue

Your Temperament May Help Determine Your Cardiac Future

Research suggests that patients who embrace change and remain optimistic may have a more positive prognosis.

The way you approach challenges and opportunities in your life could help predict your future heart health, especially once you have been diagnosed with acute coronary syndrome (ACS), a condition that

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results from reduced blood flow to the heart. Research by French investigators, published in the May issue of Psychotherapy and Psychosomatics, suggests that certain temperament traits are related to the risk of clinical events.

For example, patients with a Novelty Seeking (NS) trait, tended to have a lower risk of cardiac effects and clinical events, while individuals who score high in Harm Avoidance (HA) traits tended to have a higher risk of severe cardiac events, such as a heart attack. The study of nearly 300 men and women who had been hospitalized for ACS helps reaffirm previous research that shows certain personality traits tend to be associated with various cardiovascular outcomes, says Cleveland Clinic psychiatrist Leo Pozuelo, MD.

ACS covers a range of symptoms all related to a blockage or reduction of blood flow in the coronary arteries. The results can include stable angina, heart attack or even sudden cardiac death. Treatment can include anti-platelet drugs, interventions such as angioplasty and stenting, or even bypass surgery if the blockage is severe.

"We know that hostility and anger are associated with a higher risk of atherosclerosis," Dr. Pozuelo says. "And we know that people who are able to embrace change and are more adaptive tend to have a better prognosis than those who arenít willing to make changes in their lives."

Researchers relied on special temperament questionnaires to come up with personality trait profiles for each of the subjects in the study.

Interestingly, however, when researchers included depression into their evaluation of how various traits affected patients, the effects of NS were no longer clinically significant. This fact may help emphasize the seriousness of depression on heart health, and that even patients with certain protective traits may lose some of that protection if they are depressed.

Traits and Behaviors

While the NS trait, for instance, is also associated with disorderliness and impulsivity, individuals who score high in NS also find rewards in trying new things and are more willing to adjust their behaviors as circumstances change. So for heart patients who must make dietary and exercise changes, having strong NS tendencies could make a big difference in how they cope with their conditions.

Patients high in HA, however, tend to be shy and socially inhibited, fear uncertainty and are often anxious. These qualities are similar to those identified in Type D personalities. Type D individuals tend to be depressed, anxious, stressed, pessimistic, angry and lonely. Previous studies have shown that Type D personalities are as much as three times higher to have heart troubles as those who tend to be less anxious and more even-keeled and optimistic about their futures.

Dr. Pozuelo notes that HA or Type D patients may face greater heart risks, partly because stress chemicals released by the brain raise inflammation levels in the body, which in turn raises cardiovascular risks. In addition, these individuals may be less likely to participate in cardiac rehabilitation programs and participate in other healthy lifestyle changes that would benefit their heart health.

"This is really about more than modifying your personality," he explains. "You want to identify traits that can be detrimental and address those as best you can."