Association Between Type D Personality and Prognosis in Patients with Cardiovascular Diseases: a Systematic Review and Meta-analysis

Since 1995, the association of type D personality and mortality in patients with cardiovascular diseases has been increasingly investigated. The aim of this meta-analysis was to integrate conflicting results and to examine possible moderators of this association. Prospective studies assessing type D personality and hard endpoints were selected and pooled in meta-analyses. Cardiovascular diagnosis, type and quality of adjustment, and publication date were examined in moderator analyses. Twelve studies on patients with cardiovascular diseases ( = 5,341) were included. Pooled crude and adjusted effects demonstrated a significant association of type D personality and hard endpoints (odds ratio (OR) of 2.28 (95% CI [1.43-3.62]), adjusted hazard ratio (HR) of 2.24 (95% CI [1.37-3.66])). The OR decreased over time (OR 5.02 to OR 1.54). There was no association in congestive heart failure patients. More recent methodologically sound studies suggest that early type D studies had overestimated the prognostic relevance.