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Type-D Personality and Cortisol in Survivors of Acute Coronary Syndrome

From the Department of Epidemiology and Public Health, University College London, Torrington Place (G.J., P.C.S., A.S.); and Department of Community Health Sciences, Hunter Wing, Cranmer Terrace (L.P.P.), London, United Kingdom.

Address correspondence and reprint requests to Andrew Steptoe, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. E-mail: a.steptoe{at}ucl.ac.uk

Objective: To test the hypothesis that Type-D personality is associated with elevated cortisol levels in patients 4 months after an acute coronary syndrome (ACS).

Methods: Salivary cortisol profiles were measured at home in 70 coronary heart disease patients (Mean age = 60.90 years, SD = 10.7, 17% female) 4 months after hospitalization for ACS. Eight saliva samples were taken over the course of 1 day.

Results: Thirty eight percent of the ACS patients were defined as Type-D. Cortisol profiles showed a typical diurnal pattern, with low levels in the evening, high levels early in the day. Type-D was not related to the cortisol awakening response, but cortisol output the day was higher in Type-D (mean = 4443.3, SD = 2334.1 nmol/l) than non Type-D patients (mean = 3252.0, SD = 1810.2 nmol/l) after adjustment for age, gender, hypertension, Global Registry of Acute Coronary Events risk score, recurrence of cardiac symptoms, previous myocardial infarction, body mass index and concurrent depressed mood (p = .044). Type-D personality accounted for 6% over the variance in cortisol output over the day, after covariates had been taken into account.

Conclusion: Type-D personality may be associated with prolonged disruption of the hypothalamic-pituitary-adrenal axis function in survivors of acute cardiac events and may contribute to biological responses influencing future cardiac morbidity.

Key Words: Type-D • cortisol • HPA axis • negative affectivity • social inhibition

Abbreviations: MI = myocardial infarction; BMI = body mass index; ACS = acute coronary syndrome; CAR = cortisol awakening response; HPA = hypothalamic-pituitary-adrenal axis; SD = standard deviation; GRACE = global registry of acute coronary events.

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