Psycho-biochemical perspective on non-acute coronary syndrome: A prospective study of novel risk factors.

Type D personality (increased negative affect combined with social inhibition)
is associated with a 4-fold increased risk of mortality and adverse health
outcomes, above and beyond traditional risk factors in patients with
cardiovascular disease (CVD). However, we know little about its mechanisms, or
prognosis in the early development of CVD.
Acute coronary syndromes (ACS) such as unstable angina, or myocardial
infarction (MI) are often the result of a disruption of a stenotic vulnerable
plaque, leading to thrombotic complications. Plaques with moderate (<50%)
stenosis pose a significant risk for ACS development and mortality.
Nevertheless risk stratification in patients with moderate stenosis and
non-acute cardiac symptoms remains largely unexplored.
The atherosclerotic state preceding a cardiovascular event is a systemic
inflammatory disease. An increased inflammatory state as well as prothrombotic
factors are emerging biomarkers for plaque development, instability, and worse
prognosis. Type D personality has been related to an altered inflammatory
profile in chronic heart failure.

The goal of the proposed study is to investigate a preexisting
psycho-biochemical risk profile for major adverse cardiovascular events (MACE)
and patient perceived symptoms in a group with angiographically confirmed, but
non-acute, coronary artery disease (AC-CAD). Characterized by mild stenosis and
vascular irregularities.

Psychosocial variables and biomarkers will be measured at baseline and at one
year. The multifactorial risk profile is based on a personality risk profile
(Type D personality, and other negative affect markers), traditional risk
factors (metabolic syndrome, demographic variables), and biomarkers of
inflammation and thrombosis. MACE and patient perceived symptoms at two-year
follow-up serve as the outcome measures. Finally, the interrelationship between
Type D personality and the biomarkers at baseline and at follow-up will be
assessed to further evaluate preexisting risk factors and their changes over
time.

The proposed study incurs no extra risk to patients, as they receive no
additional treatment/ tests no will any treatment be withheld from them
compared to patients who choose not to participate or are excluded on the basis
of the exclusion criteria. Venapunctures (2) will take place, preferentially
combined with standard assessments for the clinical management of patients.
Patients will complete a set of psychological questionnaires, which is
estimated to take 1 hour. These questionnaires can be filled-out at home and
returned by pre-stamped envelope.