AUTHOR=Wang Yini , Liu Guojie , Zhao Zhenjuan , Li Ling , Yin Shi , Sun Xiao , Yu Bo , Gao Xueqin , Lin Ping , Yang Yanjie 

TITLE=The relationship between Type D personality with atherosclerotic plaque and cardiovascular events: The mediation effect of inflammation and kynurenine/tryptophan metabolism

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.986712

DOI=10.3389/fcvm.2022.986712

ISSN=2297-055X

ABSTRACT=<sec><title>Purpose</title><p>Cardiovascular events and coronary plaque vulnerability are linked to Type D personality. However, the fundamental mechanism has not been clarified. Our study determined to illustrate whether inflammatory status in plasma, in combination with kynurenine pathway activity in Type D individuals, is associated with plaque vulnerability and cardiovascular events in patients with coronary artery disease (CAD).</p></sec><sec><title>Materials and methods</title><p>The Type D personality of 177 CAD patients were evaluated. Plasma biomarkers of inflammation (TNF-α, IL-6, and hs-CRP) were measured and pooled into standardized sumscores. Tryptophan and kynurenine metabolites were measured, and the kynurenine/tryptophan ratio (KTR) was calculated. Plaque vulnerability was measured <italic>in vivo</italic> by optical coherence tomography. All patients had a follow up of 2 years in which cardiovascular adverse events were recorded.</p></sec><sec><title>Results</title><p>Type D individuals exhibited elevated TNF-α (<italic>p</italic> = 0.007), IL-6 (<italic>p</italic> = 0.049), inflammation sumscores (<italic>p</italic> = 0.002), kynurenine (<italic>p</italic> = 0.008), and KTR (<italic>p</italic> = 0.005) than non-Type D group. The serial-multiple mediation showed that the Type D personality with a direct, favorable impact on plaque vulnerability, including thin cap fibroatheroma (TCFA) (point estimate = 0.81; 95% <italic>CI</italic> = 0.09–1.53), macrophages (point estimate = 0.79; 95% <italic>CI</italic> = 0.05–1.51), and major adverse cardiac events (MACE) (point estimate = 0.88, 95% <italic>CI</italic> = 0.08–1.70). In addition, the standardized inflammation sumscores and KTR were mediators of the Type D personality associations with TCFA, macrophages and MACE.</p></sec><sec><title>Conclusion</title><p>These results demonstrated that the connection between Type D personality and poor cardiovascular outcomes in CAD patients can be mediated by pro-inflammatory biomarkers and KTR.</p></sec>