{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T03:23:48Z","timestamp":1787196228836,"version":"build-2736575974"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Psychosocial factors like type D personality (TDP) and occupational burnout are associated with increased coronary artery disease risk. This cross\u2010sectional study investigated a potential mechanism linking TDP, characterized by negative affectivity (NA) and social inhibition (SI), to coronary microvascular function in male physicians and examined burnout's potential moderating role through a balanced, stratified design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Sixty male physicians, evenly divided into burnout and nonburnout groups, underwent positron emission tomography to measure endothelium\u2010dependent coronary flow reserve (CFR) during the cold pressor test and endothelium\u2010independent CFR during adenosine\u2010induced hyperemia. TDP effects were primarily analyzed using a dimensional approach based on continuous NA and SI scores and their interaction, adjusting for physical activity and Systematic Coronary Risk Evaluation 2 or age and metabolic syndrome factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Fourteen participants (23.3%) exhibited TDP (NA and SI scores \u226510), with 92.9% also experiencing burnout. Moderator analysis was limited by the high co\u2010occurrence of burnout and TDP. A significant positive NA\u00d7SI interaction was associated with increased endothelium\u2010dependent CFR, independent of burnout, physical activity, and either Systematic Coronary Risk Evaluation 2 (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.044, partial \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      =0.074) or age and metabolic syndrome factors (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.030, partial \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      =0.087). CFR increased with higher SI scores when NA was high, and with higher NA scores when SI was high. This effect was mediated by peak rate\u2013pressure product, an indicator of sympathetic stimulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">TDP components may synergistically affect coronary microvascular function via heightened sympathetic activity. Exaggerated CFR during sympathetic stimulation may reflect a compensatory or early\u2010stage response, potentially indicative of maladaptive hyperemia and future microvascular impairment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.041273","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T11:48:08Z","timestamp":1753789688000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Synergistic Effects of Type D (\u201cDistressed\u201d) Personality Traits on Coronary Microvascular Function in Male Physicians With Occupational Burnout: A Cross\u2010Sectional Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8929-5129","authenticated-orcid":false,"given":"Roland","family":"von K\u00e4nel","sequence":"first","affiliation":[{"name":"University Hospital Zurich, University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1300-7853","authenticated-orcid":false,"given":"Paul","family":"Lodder","sequence":"additional","affiliation":[{"name":"Tilburg University","place":["Tilburg, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Holzgang","sequence":"additional","affiliation":[{"name":"University Hospital Zurich, University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Princip","sequence":"additional","affiliation":[{"name":"University Hospital Zurich, University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0938-3170","authenticated-orcid":false,"given":"Andreas A.","family":"Giannopoulos","sequence":"additional","affiliation":[{"name":"University Hospital Zurich, University of 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