The Moderating Role of Type D Personality on The Relationship Between Biomarkers and The Severity of Coronary Artery Disease

Document Type : Original Article


1 Department of Psychology, Faculty of Psychology and Educational Science, University of Tehran, Tehran, Iran.

2 Shahid Rajaei Cardiovascular Intervention Center

3 Department of Psychology, Tarbiat Modares University, Tehran, Iran


Aim: The aim of this study was to investigate the psychometric properties (validity and reliability) of the student version of the Academic Motivation Scale. Method: This study was a psychometric correlation study. The sample consisted of 400 students of the Islamic Azad University, South Tehran Branch, who were selected by available sampling method and completed the student version of the Vallerand, Pelletier, Blais, and Briere (1992) Academic Motivation Scale. Data were analyzed using expolary factor analysis, confirmatory factor analysis, Cronbach's alpha and retest. Results: The results of exploratory factor analysis showed 23 items 7 intrinsic motivation factors (with the amount of variance explained 12.85), achievement (with the amount of variance explained 11.89), identified (with the amount of variance explained 10.44), amotivation (with an explained variance of 10.40), extroversion (with an explained variance of 10.19), stimulation (with an explained variance of 7.9), and knowledge (with an explained variance of 6.57). The results of confirmatory factor analysis confirmed the findings of exploratory factor analysis. Fit indices were obtained in both models of confirmatory factor analysis at the appropriate level of 0.001. The overall reliability coefficient of the scale was obtained by Cronbach's alpha (0.88) and retest method (0.86) for the desired level. Conclusion: The results of the study showed that the student version of the Academic Motivation Scale has good validity and reliability and can be used to measure academic motivation in students.


A Report From the American Heart Association. Heart Disease and Stroke Statistics—2020 Update. Circulation. .]Link]
Brown, J. C., Gerhardt, T. E., & Kwon, E. (2020). Risk factors for coronary artery disease, in StatPearls. [Link]
China, N. B. O. S. China Statistical Yearbook, 2019 (China Statistic Press, Beijing, 2019). [Link]
Conden, E., Leppert, J., Ekselius, L., & Åslund, C. (2013). Type D personality is a risk factor for psychosomatic symptoms and musculoskeletal pain among adolescents: a cross-sectional study of a large population-based cohort of Swedish adolescents. BMC Pediatrics, 13(11), 1–9. [Link]
Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and type D personality. Psychosomatic Medicine, 67(1): 89–97. [Link]
Denollet, J., Pedersen, S.S., Vrints, C.J., & Conraads, V. M. (2006). Usefulness of TypeD personality in predicting five-year cardiac events above andbeyondConcurrent symptoms of stress in patients with coronary heart disease.American Journal of Cardiology, 97: 970-973. [Link]
Denollet, J., Schiffer, A.A., & Spek, V. (2010). A general propensity to psychologicaldistress affects cardiovascular outcomes: evidence from research onthe type D (distressed) personality profile. Circulation CardiovascularQuality and Outcomes,3: 546-557. [Link]
Denollet, J., Trompetter, H. R., & Kupper, N. (2021). A review and conceptual model of the association of Type D Personality with suicide risk. Journal of Psychiatric Research, 138: 291–300. [Link]
Denollet, J., Vaes, J., & Brutsaert, D. L. (2000), Inadequate response to treatment in coronary heart disease: adverse effects of Type D personality and younger age on 5-year prognosis and quality of life. Circulation, 102: 630-635. [Link]
Denollet, J., Vaes, J., & Brutsaert, D. L. (2000). Inadequate response to treatment in coronary heart disease: adverse effecs of type-D personality and younger age on 5-year prognosis and qulity of life. Circulation, 102: 630-5. [Link]
Du, J., Zhang, D., Yin, Y., Zhang, X., Li, J., Liu, D., Pan, F., Chen, W. (2016). The personality and psychological stress predict major adverse cardiovascular events in patients with coronary heart disease after percutaneous coronary intervention for five years. Medicine, 95(15): e3364. [Link]
Durmus, G., Belen, E., Can, M. M. (2018). Increased neutrophil to lymphocyte ratio predicts myocardial injury in patients undergoing non-cardiac surgery. Heart Lung. 47(3): 243-7. [Link]
Enatescu, V. R., Cozma, D., Tint, D., Enatescu, I., Simu, M., Giurgi-Oncu, C. Lazar, M. A., & Mornos, C. (2021). The Relationship Between Type D personality and the Complexity of Coronary Artery Disease. Neuropsychiatric Disease and Treatment. 17: 809-820. [Link]
Girolamo, C. D., Nusselder, W. J., Bopp, M., Bronnum-Hansen, H., Costa, G., Kovacs, K., Leinsalu,  M., Martikainen, P., Pacelli, B., Valverde, J. R., & Mackenbach, J. P. (2020). Progress in reducing inequalities in cardiovascular disease mortality in europe. Heart, 106: 40-49 . [Link]
Heart Disease Statistics and Maps. Available at: https :// disea se/stati stics maps.htm. Accessed 29 March 2020. [Link]
Hiroshi, K. & Tsukasa, M. (1996). Band neutrophil count and the presence and severity of coronary atheroscleresis. Am Heart J.132 (1): 9-12. [Link]
Izhaki, A., Slesarenko, Y., Boaz, M., Haimovich, Y., & Rozenman, Y. (2011) Cardiac troponin T: an important predictor of late death and myocardial infarction following hip fracture: an eight-year prospective observational cohort study. Eur J Orthop Surg Traumatol, 21(4): 243–249. [Link]
Kontos, C. M., Shah, P., Fritz, M. L., Anderson, P., Tatum, L. J., Ornato, P. J. & Jesse. L., R. (2004). Implication of Different Cardiac Troponin I Levels for Clinical Outcomes and Prognosis of Acute Chest Pain Patients. Journal of the American College of Cardiology, 43(6): 958-965. [Link]
Kristono, G. A., Holley, A. S., Harding, S. A., & Larsen, P. D. (2020). White blood cell subtypes as predictors of adverse cardiac events, Coronary Artery Disease.Vol 31. No 5. [Link]
Leu, H., Yin, W., Tseng, W., Wu, Y., Lin, T., Yeh, H., Chang, K., Wang, J., Wu, C., & Chen, J. (2019). Impact of type D personality on clinical outcomes in Asian patients with stable coronary artery disease. Journal of the Formosan Medical Association. 118: 721-729. [Link]
Lowe, M J., & Lightfood, N. J. (2020). The prognostic implication of perioperative cardiac enzyme elevation in patients with fractured neck of femur: A systematic review and meta-analysis, Injury, 51: 164–173. [Link]
Madjid, M. & Fatemi, O. (2013). Components of the Complete Blood Count as Risk Predictors for Coronary Heart Disease. Texas Heart Institute Journal. 40,1, 17-29. [Link]
Mols, F., & Denollet, J. (2010)a. Type D personality among noncardiovascular patientpopulations: a systematic review. General Hospital Psychiatry, 32: 66-72. [Link]
Mols, F., & Denollet, J. (2010)b. Type D personality in the general population: asystematic review of health status, mechanisms of disease, and workrelatedproblems. Health and Quality of Life Outcomes. 8, 9. [Link]
Moryś, J. M., Bellwon, J., Jeżewska, M., Adamczyk, K., & Gruchała, M. (2015). The evaluation of stress coping styles and type D personality in patients with coronary artery disease. Kardiologia Polska, 73(7): 557–566. [Link]
Mueller, C. Neumann, F., J. Perruchoud, A., P. Buettner, H., J. (2003). syndrome treated with very early revascularisation. Heart, 89(4): 389-92. [Link]
Norring-Agerskov, D., Madsen, C. M., Bathum, L., Pedersen, O. B., Lauritzen, J. B., & Jorgensen, N. R. (2019). History of cardiovascular disease and cardiovascular biomarkers are associalted with 30-day mortality in patients with hip fracture, [Link]
Núñez, J., Miñana, G., Bodí, V., Núñez, E., Sanchis, J., Husser, O., & Liacer, A. (2011). Low lymphocyte count and cardiovascular diseases. Curr Med Chem.18(21): 3226-33. [Link]
O'Dell, K. R., Masters, K. S., Spielmans, G. I., & Maisto, S. A. (2011), Does type-D personality predict outcomes among patients with cardiovascular disease? A meta-analytic review. Journal of Psychosomatic Research, 71: 199-206. [Link]
Pedersen, S. S., & Denollet, J. (2006). Is Type D personality here to stay?emerging evidence across cardiovascular-disease patient groups. Current Cardiology Review, 2: 205-213. [Link]
Ridker, P. M., Everett, M. B., Thuren, T., MacFadyen, G, J., Chang, W. H., Ballantyne, C., Fonseca, F., Nicolau, J., Koenig, W., Anker, S. D., Kastelin, J. Cornel, J. H. (2017). Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med, 377: 1119–1131. [Link]
Sabatine, M. S., Morrow, D. A., Cannon, C. P., Murphy, S. A., Demopoulos, L. A., DiBattiste, P. M., McCaba, C. H., Braunwald, E., & Gibson, C. M.  (2003). Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 trial) substudy. J Am Coll Cardiol. 40(10): 1761-1768. [Link]
Sarrafzadegan, N., & Mohammadifard, N. (2019). Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med. 22(4): 204-210. [Link]
Shimbo, D., Chaplin, W., Crossman, D., Hass, D., & Davidson, W. K. (2005). Role of Depression and Inflammation in Incident Coronary Heart Disease Events, doi:10.1016/j.amjcard.05.064. [Link]
Sugiyama, T., Kanaji, Y., Hoshino, M., Yamaguchi, M., Hada, M., Ohya, H., Sumino, Y., Hirano, H,m Kanno, Y., Horie, T., Misawa, T., Nogami, K., Ueno, H., Hamaya, R., Usui, E. (2020). Determinants of Pericoronary Adipose Tissue Attenuation on Computed Tomography Angiography in Coronary Artery Disease. Journal of the American Heart Association. 9, 15, doi/suppl/ 10.1161/JAHA.120.016202. [Link]
Tahto, E., Jadric, R., Pojskic, L., & Kicic, E. (2019). Neutrophil-tolymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Coronary Syndrome. Med Arch.71(5): 312-5. [Link]
Timmis, A., Gale, C. P., Flather, M., Maniadakis, N. & Vardas, P. (2018). Cardiovascular disease statistics from the European atlas: inequalities between high- and middle-income member countries of the ESC. Eur. Heart J. Qual. Care Clin. Outcomes, 4: 1–3. [Link]
Uthamalingam, S., Patvardhan, E. A., Subramanian, S., Ahmed, W., Martin, W., Daley, M., & Capodilupo, R. (2011). Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol, 107(3):433-8. [Link]
Wasniowska, A., Kopec, G., Szafraniec, K., Kozela, M., Sarnecka, A., Knap, K., Pajak, A., & Podolec, P. (2018). Knowledge of cardiovascular disease (CVD) risk factors in population of Małopolska voivodeship in two independent cross-sectional studies. Przegl. Epidemiol, 72: 75–85. [Link]
Weiner, D., E, Tighiouart, H, Elsayed, E.,F, Griffith, J., L. Salem, D., N. Levey, A., S.  & Sarnak, M. J. (2008). Inflammation and cardiovascular events in individuals with and without chronic kidney disease. Kidney Int, 73(12):1406-1412. [Link]
World Health Organization. (2018). The top 10 causes of death. Retrieved https://www. ofdeath#targetText¼Ischaemic%20heart%20disease%20and%20stroke,in%20the%20last% 2015%20years. [Link]
Xu, R., Ye, P., Luo, L., Sheng, L., Wu, H. Xiao, W., Zheng, J., Wang, F., & Xiao, T. (2012). Association between high-sensivity cardiac troponin and predicted cardiovascular risks in a community-based population. Int J Cardiol. 149 (2): 253-256. [Link]
Zenn, M. R. (2011). Fluorescent Angiography. Clinics in Plastic Sutgery, 38: 293-300. [Link]
Zhou, M., Wang, H., Zeng, X., Yin, P., Zhu, J., Chen, W., Li, X., Wang, L., Wang, L., Liu, Y., Liu, J., Zhang, M., Qi, J., Yu, S., Afshin, A., Cakidou, E., Glenn, S., Krish, V. S. (2019).Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 394: 1145–1158. [Link]