Simpele vragenlijst voorspelt hartziekte.*

De klinische psycholoog Johan Denollet heeft een test ontwikkeld die het risico op een hartaanval voorspelt. Volgens het Amerikaanse magazine Newsweek opent de Antwerpenaar daarmee een nieuw actieterrein in de cardiologie.
Het idee om het risicoprofiel te meten via een vragenlijst, kreeg Denollet een tiental jaar geleden bij zijn werk in het revalidatiecentrum cardiologie UZ Antwerpen. Daar stelde hij vast dat sommige overlevers opgewekt bleven en spontaan meewerkten aan de revalidatie, terwijl anderen ontmoedigd waren en veel klaagden.
Uit verder onderzoek bleek dat een bepaald type patiënten het meest kwetsbaar is: zij die negatieve gevoelens - piekeren, wanhoop, prikkelbaarheid - combineren met innerlijke remmingen. Het zogenaamde type D. Mensen van dit type lopen drie tot vier keer meer kans op een hartaanval en een voortijdige dood.
Denollet ontwikkelde een lijst met 14 vragen die dat risicoprofiel in kaart brengt. Volgens de uitvinder is de voorspellende waarde van zijn test groter dan die van medische risicofactoren. Hier kunt u de test uitvoeren.

The Dangers of Chronic Distress

Are you worried, irritable and socially inhibited? A simple test may help predict the health effects.

- Years ago, when the psychologist Johan Denollet was first working with cardiac patients at a university hospital in Antwerp, Belgium, he noticed a paradox. Some heart-attack survivors remained cheerful and optimistic despite extensive cardiac damage. They joined eagerly in rehabilitation programs and adhered to them. Others grew discouraged. They resisted rehab, even after milder heart attacks, and spent most of their energy complaining. Denollet, now a professor of medical psychology at Tilburg University in the Netherlands, suspected there was something fundamentally different about these two groups of patients. So he set out to find a way of measuring it. The tool he developed—a simple, 14-question personality test known as the DS14—is now opening a new frontier in cardiology.

The test, which accompanies this article, defines overall distress in terms of two emotional states: "negative affectivity" (worry, irritability, gloom) and "social inhibition" (reticence and a lack of self-assurance). It may sound more like a parlor game than a medical instrument—but in the research to date, it has been a surprisingly powerful predictor of cardiovascular health. High distress scores are strongly associated with both hypertension and coronary heart disease. And among people who already have heart conditions, those with the highest distress scores—the so-called Type D personalities—are less responsive to treatment and have a poorer quality of life. They are also more likely to die prematurely.

This isn't the first attempt to link personality to medical risk. During the 1960s and '70s, psychologists devised a short alphabet to describe different tendencies. Type A's—the weekend-working perfectionist strivers—were deemed likely candidates for heart disease. Relaxed, noncompetitive Type B's were supposed to be models of health. And Type C's—outwardly pleasant people who avoid conflict by suppressing their feelings—were said to be cancer-prone. The ABC model fell apart in the 1980s, when large studies found no reliable connection between the Type A personality and heart disease. The effort wasn't wasted, though. Subsequent research has helped pinpoint truly harmful emotions, such as anxiety, hostility and hopelessness—and the D scale has given researchers an easy way to measure several of them at once.

How strongly could your distress score affect your health? Consider what happened when Denollet's group administered an earlier version of the test to 300 people in a cardiac-rehabilitation program in Antwerp. Within 10 years, 27 percent of the Type D patients had died—mostly of heart disease or stroke—compared with 7 percent of the others. In a more recent study, researchers in the Netherlands gave a Type D questionnaire to 875 patients who had recently received stents to open their coronary arteries. The study found that Type D patients were more than four times as likely as others to experience heart attack or death within six to nine months of the procedure.

The DS14 is looking more and more like a parlor game worth playing. But don't panic if you score at the high end of the scale. Type D personality itself is not a mental illness. It is a collection of normal human traits. And as Denollet is quick to point out, "there are many Type D individuals who are living healthy lives and functioning quite well." A good marriage can be an antidote to social inhibition, especially if your partner's ease with people compensates for your own discomfort. And even the most distress-prone person can learn through psychotherapy to cope with stress and beat back anxious thoughts. Many Type D people have trouble seeking help—by definition, they're ill at ease and afraid to open up—but physicians and family members can help them over those hurdles. And the test itself can help Type D people own up to their fears and frustrations, since it doesn't require any embarrassing social interaction.

Even if you never fully conquer your distress, you can take practical steps to make it less toxic to your health. Exercise and a wholesome diet will reduce almost anyone's risk of a heart attack. And lifestyle changes that protect your heart can improve your emotional state as well. In a 2001 study, Denollet found that comprehensive cardiac-rehab programs boosted people's moods as well as their survival rates, making their lives both richer and longer. "Warding off emotional distress," he concluded, "may be one mechanism to explain the beneficial effect of rehabilitation on prognosis."

It's still too early to know if the Type D will have more staying power than the A, B or C. Researchers have to test the concept across many cultures. And no one has shown conclusively that easing your distress—whether through meditation, talk therapy or antidepressants—can help prevent heart attacks. For now, feeling better will have to be an end in itself. So take the test, and don't fear the result. You can use it to your advantage.( Okt. 2005)