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BACKGROUND:
A type D (or distressed) personality is associated with negative affectivity and social inhibition and is an independent predictor of morbidity and mortality in patients with cardiac disease. There is little data on this personality type in patients with intermittent claudication (IC). The purpose of this study is to evaluate the difference in objective measures of ambulation in patients with IC stratified by personality type.
METHODS:
Over a one year period, routine history and physical, ankle brachial index (ABI), and pulse volume recording (PVR) were performed on IC patients. Questionnaires assessing personality type, psychosocial factors and perception of disease severity were recorded (Vascular Quality of Life, Walking Impairment Questionnaire, Hospital Anxiety and Depression Scale, Positive Health Expectations, and Type D Scale). A six minute
walk test (6MWT) was performed measuring distance to symptoms, total distance walked, and total time walked. Univariate and multivariate methods were used to assess the correlation between ambulation and type D personality.
RESULTS:
Seventy one patients were enrolled with a mean age of 62.5±1.14 years and mean ABI of 0.55+/-0.03. Mean distance to symptoms, and total distance walked were 83.7±80.1 m, and 206.5±126.3 m respectively. There were no significant correlations between the type D group and the questionnaires assessing psychosocial factors and perception of disease
severity. At 6MWT, 83.1% of the patients developed symptoms, and 57.4% quit because of symptoms. Type D personality was present in 29.6% of the population (study, n = 21). Compared to the non-type D population (control, n = 50), there were no differences in demographic factors, comorbidities, or baseline ABI. Univariate analysis of objective measures of ambulation (Table) demonstrate statistically significant lower distance to symptoms in the study group, and trends towards lower total distance walked and quitting the 6MWT. A logistic regression model for patients who quit the 6MWT found that the study group had increased odds of quitting (OR 7.71, p = 0.009) when controlling for confounders. A multiple linear regression model for total distance walked showed that the study group walked an average of 33.2±13.3 meters less than the control group (p = 0.016) when controlling for confounding variables.
CONCLUSIONS:
Despite equivalent demographics, comorbidities, baseline ABI, and perception of disease severity, the study group was limited in ambulation distance and more likely to quit the 6MWT. These data suggest that personality type is a strong predictor of disease impact in patients
with IC. Further study is needed regarding progression of disease and response to treatment based on type D personality.

Univariate analysis of objective ambulation outcomes

Variable	Study (Type D, n=21)	Control (n=50)	P
Age (y)	60.9±2.0	63.1±1.4	0.36
ABI	0.55±0.26	0.55±0.19	0.93
6MWT Quit	70.0%	52.1%	0.17
6MWT Developed Symptoms	76.2%	86.0%	0.33
6MWT Distance to Symptoms (m)	57.4±12.3	93.4±13.3	0.05
6MWT Total Distance (m)	170.3±25.0	221.6±18.8	0.11