Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Meta-analysis.

OBJECTIVE: Type D personality, a joint tendency toward negative affectivity and social inhibition, has been linked to adverse events in patients with heart disease, although with inconsistent findings. Here, we apply an individual patient-data meta-analysis to data from 19 prospective cohort studies ( N = 11,151) to investigate the prediction of adverse outcomes by type D personality in patients with acquired cardiovascular disease. METHOD: For each outcome (all-cause mortality, cardiac mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiac event, any adverse event), we estimated type D's prognostic influence and the moderation by age, sex, and disease type. RESULTS: In patients with cardiovascular disease, evidence for a type D effect in terms of the Bayes factor (BF) was strong for major adverse cardiac event (BF = 42.5; odds ratio [OR] = 1.14) and any adverse event (BF = 129.4; OR = 1.15). Evidence for the null hypothesis was found for all-cause mortality (BF = 45.9; OR = 1.03), cardiac mortality (BF = 23.7; OR = 0.99), and myocardial infarction (BF = 16.9; OR = 1.12), suggesting that type D had no effect on these outcomes. This evidence was similar in the subset of patients with coronary artery disease (CAD), but inconclusive for patients with heart failure (HF). Positive effects were found for negative affectivity on cardiac and all-cause mortality, with the latter being more pronounced in male than female patients. CONCLUSION: Across 19 prospective cohort studies, type D predicts adverse events in patients with CAD, whereas evidence in patients with HF was inconclusive. In both patients with CAD and HF, we found evidence for a null effect of type D on cardiac and all-cause mortality.

Cardio-Ankle Vascular Index in the Persons with Pre-Diabetes and Diabetes Mellitus in the Population Sample of the Russian Federation.

The aim of this study was to evaluate Cardio-Ankle Vascular Index (CAVI) and increased arterial stiffness predictors in patients with carbohydrate metabolism disorders (CMD) in the population sample of Russian Federation. METHODS: 1617 patients (age 25-64 years) were enrolled in an observational cross-sectional study Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Regions of the Russian Federation (ESSE-RF). The standard ESSE-RF protocol has been extended to measure the cardio-ankle vascular index (CAVI), a marker of arterial stiffness. Patients were divided into three groups: patients with type 2 diabetes mellitus (n = 272), patients with prediabetes (n = 44), and persons without CMD (n = 1301). RESULTS: Median CAVI was higher in diabetes and prediabetes groups compared with group without CMD (p = 0.009 and p < 0.001, respectively). Elevated CAVI (≥9.0) was detected in 16.8% of diabetes patients, in 15.9% of those with prediabetes, and in 9.0% of those without CMD (p < 0.001). The factors affecting on CAVI did not differ in CVD groups. In logistic regression the visceral obesity, increasing systolic blood pressure (SBP) and decreasing glomerular filtration rate (GFR) were associated with a pathological CAVI in CMD patients, and age, diastolic blood pressure (DBP), and cholesterol in persons without CMD. CONCLUSIONS: the CAVI index values in the prediabetes and diabetes patients were higher than in normoglycemic persons in a population sample of the Russian Federation. Since the identified disorders of arterial stiffness in prediabetes are similar to those in diabetes, their identification is important to prevent further cardiovascular complications.

Assessment of Arterial Stiffness by Cardio-Ankle Vascular Index for Prediction of Five-Year Cardiovascular Events After Coronary Artery Bypass Surgery.

The study aim was to investigate the possibility of cardiovascular complications development predicting during a five-year follow-up of patients after coronary artery bypass grafting (CABG) using the cardio-ankle vascular index (CAVI) assessment. Methods: Three hundred and fifty-six patients after elective CABG were enrolled in the study. Prior to surgery, arterial stiffness was assessed in all patients using CAVI. The follow-up was performed five years after the surgery, information was obtained on 238 patients, who were divided into two groups: patients with pathological (≥9.0, n = 88), and normal (<9.0, n = 150) CAVI. Results: Pathological CAVI (≥9.0) was detected in 33% patients before CABG, in stepwise analyses only age and left atrium dimensions statistically significantly predicted CAVI. In patients with pathological CAVI the combined endpoint (major adverse cardiovascular events and hospitalization) and cardiovascular death developed more often in a five-year follow-up after CABG compared with normal CAVI (48.86% versus 34.9%, p = 0.034 and 4.55% versus 0.67%, p = 0.049, respectively). Pathological CAVI (p = 0.021) and the number of coronary bypass grafts (p = 0.023) were independent factors associated with the combined endpoint. Conclusions: Patients with pathological CAVI before CABG surgery are more likely to develop cardiovascular complications and cardiovascular death within a subsequent five-year follow-up. Evaluation of CAVI after CABG in dynamics deserves further study, it is important for monitoring the effects of secondary prevention and the possibility of influencing the prognosis.