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Psychosomatic Medicine:
doi: 10.1097/PSY.0b013e3181bee6dc
Original Articles

Association Between Type D Personality, Depression, and Oxidative Stress in Patients With Chronic Heart Failure

Kupper, Nina PhD; Gidron, Yori PhD; Winter, Jobst MD, PhD; Denollet, Johan PhD

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Abstract

Objective: To examine whether markers of oxidative stress differ as a function of Type D personality, depression, and chronic heart failure (CHF) etiology. Type D (distressed) personality and depression are related to poor cardiac prognosis. Because patients with CHF are characterized by increased oxidative stress, this may be a candidate mechanism responsible for the adverse prognosis in emotionally distressed patients with CHF.

Methods: Serum levels of xanthine oxidase (XO), inducible heat shock protein (Hsp)70, and deoxyribonucleic acid damage marker 8-OHdG were measured in 122 patients, and effects of Type D, depression, and etiology were assessed.

Results: CHF patients with Type D personality had lower levels of Hsp70 than non-Type D patients (6.48 ng/mL versus 7.85 ng/mL, p = .04, d = 0.26), and in case of an ischemic etiology, higher levels of XO (13.57 ng/mL versus 9.84 ng/mL, p = .01, d = 0.98). There were no significant univariate differences for depression. When adding depression as an additional independent variable in the Type D analysis, the effect of Type D personality remained significant (F = 5.460, p = .02) and was independent of depression (F = 0.942, p = .33). The ratio of XO to Hsp70 was significantly higher in Type D patients with CHF as compared with non-Type D patients (6.14 versus 2.83, p = .03, d = 0.39), independent of etiology class.

Conclusion: CHF patients with Type D personality are characterized by an increased oxidative stress burden, apparent in the decreased antioxidant levels and an increased oxidative stress ratio.

8-OHdG = 8-hydroxy-2-deoxyguanosine; ACE = angiotensin-converting enzyme; CHF = chronic heart failure; ELISA = enzyme-linked immunosorbent assay; HF = heart failure; Hsp70 = heat shock protein 70; LVEF = left ventricular ejection fraction; MANOVA = multivariate analysis of variance; MDD = major depressive disorder; MI = myocardial infarction; NA = negative affectivity; ROS = reactive oxygen species; SI = social inhibition; TNF = tumor necrosis factor; XO = xanthine oxidase.

Copyright © 2009 by American Psychosomatic Society

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