Cytokines and immune activation in systolic heart failure: the role of Type D personality

The proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) and its soluble receptors 1 (sTNFR1) and 2 (sTNFR2) are predictors of mortality in chronic heart failure (CHF) but the determinants of these increased levels of disease-promoting cytokines are largely unknown. Type D personality refers to the combination of the tendency to experience negative emotions (negative affectivity) and the tendency to inhibit the expression of emotions in social interaction (social inhibition). Type D is an independent predictor of cardiac events in coronary patients who are at risk for CHF. The present study examined the effect of Type D personality on TNF-alpha, sTNFR1, and sTNFR2 in 42 men with CHF (mean age = 57.9 +/- 10.5 years). There was a significant multivariate effect of Type D on TNF-alpha measures (p = .006); i.e., circulating levels of TNF-alpha (4.8 +/- 0.9 versus 2.5 +/- 0.2 pg/ml, p = .003), sTNFR1 (1814 +/- 314 versus 1134 +/- 78 pg/ml, p = .014), and sTNFR2 (2465 +/- 243 versus 1874 +/- 118 pg/ml, p = .019) were significantly higher in Type D patients as compared to non-Type D patients. The effect size (ES) of Type D personality ranged from rather large (sTNFR1, ES = 0.77; sTNFR2, ES = 0.73) to large (TNF-alpha, ES = 0.90). After controlling for ischemic etiology and severity of heart failure, Type D personality emerged as an independent predictor of increased circulating levels of both TNF-alpha (OR = 9.5, 95% CI 2.1-43.8, p = .004) and TNF-alpha receptors (OR = 6.1, 95% CI 1.4-25.8, p = .014). These findings are consistent with the prognostic power of Type D personality regarding long-term morbidity and mortality in patients with established coronary heart disease. This study suggests that individual differences in personality contribute to the psychoneuroimmunological aspects of heart failure. (C) 2003 Elsevier Science (USA). All rights reserved.