Moderating effect of Lifestyle and Type D personality on the Relationship between Metabolic Syndrome and Severity of Coronary Artery Disease

In-Kyoung Noh; Myoung Soo Kim

doi:10.7475/kjan.2018.30.3.290

Journal List > Korean J Adult Nurs > v.30(3) > 1099908

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Noh and Kim: Moderating effect of Lifestyle and Type D personality on the Relationship between Metabolic Syndrome and Severity of Coronary Artery Disease

Original Article

Korean J Adult Nurs 2018;30(3):290-300.

Published online: 21 June 2018

DOI: https://doi.org/10.7475/kjan.2018.30.3.290

Moderating effect of Lifestyle and Type D personality on the Relationship between Metabolic Syndrome and Severity of Coronary Artery Disease

In-Kyoung Noh¹, Myoung Soo Kim^2,

¹Kosin University Gospel Hospital, Busan, Korea

²Department of Nursing, Pukyong National University, Busan, Korea

Corresponding author: Kim, Myoung Soo https://orcid.org/0000-0002-1773-1374 Department of Nursing, Pukyong National University, Daeyeon Campus, 45, Yongso-ro, Nam-gu, Busan 48513, Korea. Tel: +82-51-629-5782, Fax: +82-51-629-5789, E-mail: kanosa@pknu.ac.kr

Received 18 April 201812 May 2018 Accepted 7 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purposes of this study were to investigate the moderating effect of lifestyle and Type-D personality on the relation between metabolic syndrome and severity of coronary artery disease and to provide practical knowledge and directions for nursing intervention.

Methods

The participants were 111 adult outpatients with coronary artery disease in the cardiology department of a medical center in Korea. The study tools included diagnostic criteria for metabolic syndrome, lifestyle evaluation tool for patients with metabolic syndrome, the Korean Type-D scale-14, and measures of severity of coronary artery disease. The data were obtained by electronic medical record reviews and surveys using structured questionnaires and interviews. Data were analyzed using descriptive statistics, x² test, independent t-test, one-way ANOVA, Pearson's correlation coefficient, multiple linear regression analysis and two-way ANOVA.

Results

The severity of coronary artery disease was positively correlated with the presence of metabolic syndrome (r=.26, p=.006) and type-D personality (r=.49, p<.001). There was a significant negative correlation (r=-.54, p<.001) between the severity of coronary artery disease and lifestyle. Lifestyle had the moderating effect on the relationship between metabolic syndrome and severity of coronary artery disease (β=-.22, p<.001), but type-D personality had no moderating effect (F=0.13, p=.719) on it.

Conclusion

Based on the results of this study, it is necessary to establish individualized intervention considering the condition of the patients according to the criteria of the metabolic syndrome diagnosis when establishing the lifestyle intervention plan. And also it is necessary to define influencing factors including the personality on lifestyle change.

Keywords: Metabolic syndrome, Coronary artery disease, Severity of illness index, Life style, Type D personality

REFERENCES

1. Broddadottir H, Jensen L, Norris C, Graham M. Health-related quality of life in women with coronary artery disease. European Journal of Cardiovascular Nursing. 2009; 8(1):18–25. https://doi.org/10.1016/j.ejcnurse.2008.05.002.

2. Health Insurance Review & Assessment Service. 2015 Ischemic heart disease. [Internet]. Wonju: Author;2016. [cited 2016 September 27]. Available from:. http://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020041000100&brdScnBltNo=4&brdBltNo=9226. http://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020041000100&brdScnBltNo=4&brdBltNo=9226.

3. Stirrat C, Mann S. Perceptions of cardiovascular risk factors among cardiology outpatients. Heart, Lung and Circulation. 2008; 17:S22–3. https://doi.org/10.1016/j.hlc.2008.03.051.

4. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet. 2004; 364(9438):937–52. https://doi.org/10.1016/S0140-6736(04)17018-9.

5. American Heart Association. Coronary Heart Disease [Internet]. Dallas: Author;2017. [cited 2017 April 26]. Available from:. https://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp#.WPi-F8uwdMx.

6. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and metaanalysis. Journal of the American College of Cardiology. 2010; 56(14):1113–32. https://doi.org/10.1016/j.jacc.2010.05.034.

7. Seo H, Yoon SJ, Yoon J, Kim D, Gong Y, Kim AR, et al. Recent trends in economic burden of acute myocardial infarction in south Korea. PLoS One. 2015; 10(2):e0117446. https://doi.org/10.1371/journal.pone.0117446.

8. Kimbro LB, Steers WN, Mangione CM, Duru OK, Ettner SL. The association of depression and the cardiovascular risk factors of blood pressure, HbA1c, and body mass index among patients with diabetes: results from the translating research into action for diabetes study. International Journal of Endocrinology. 2012; 2012:747460. https://doi.org/10.1155/2012/747460.

9. Kim SH, Choi HS, Ji SH, Park YM, Cho KH. The relationship of the prevalence metabolic syndrome and the difference of life style in Korean adult. Korean Journal of Family Practice. 2015; 5(Suppl 3):500–9.

10. Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of “ ideal cardiovascular health” in a communitybased population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation. 2011; 123(8):850–7. https://doi.org/10.1161/CIRCULATIONAHA.110.980151.

11. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annual Reviews of Public Health. 2005; 26:469–500. https://doi.org/10.1146/annurev.publhealth.26.021304.144542.

12. Tak YR, An JY, Kim YA, Woo HY. The effects of a physical activity-behavior modification combined intervention (PABM-intervention) on metabolic risk factors in overweight and obese elementary school children. Journal of Korean Academy of Nursing. 2007; 37(6):902–13. https://doi.org/10.4040/jkan.2007.37.6.902.

13. Bang SY, Park MY. The analysis of risk factor management programs for patients with coronary artery disease. The Korean Journal of Rehabilitation Nursing. 2013; 16(1):27–36. https://doi.org/10.7587/kjrehn.2013.27.

14. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and type D personality. Psychosomatic Medicine. 2005; 67(1):89–97.

15. Du J, Zhang D, Yin Y, Zhang X, Li J, Liu D, et al. The personality and psychological stress predict major adverse cardiovascular events in patients with coronary heart disease after percutaneous coronary intervention for five years. Medicine. 2016; 95(15):e3364. https://doi.org/10.1097/MD.0000000000003364.

16. Denollet J, Pedersen SS, Ong AT, Erdman RA, Serruys PW, van Domburg RT. Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era. European Heart Journal. 2006; 27(2):171–7. https://doi.org/10.1093/eurheartj/ehi616.

17. Cao X, Wang XH, Wong EM, Chow CK, Chai SY. Type D personality negatively associated with self-care in Chinese heart failure patients. Journal of Geriatric Cardiology. 2016; 13(5):401–7. https://doi.org/10.11909/j.issn.1671-5411.2016.05.011.

18. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabetic Medicine. 1998; 15(7):539–53. https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S.

19. Shin HM, Jee SH, Kim JH, Kim MR. The influence on cardiovascular mortality of the metabolic syndrome in Korean post-menopausal women. The Journal of Korean Society of Meno-pause. 2012; 18(1):6–14. https://doi.org/10.6118/jksm.2012.18.1.6.

20. Kang SW. The validity and reliability of a lifestyle evaluation tool for patients with metabolic syndrome. Journal of Korean Academy of Fundamentals of Nursing. 2010; 17(4):487–97.

21. Lim HE, Lee MS, Ko YH, Park YM, Joe SH, Kim YK, et al. Assessment of the type D personality construct in the Korean population: a validation study of the Korean DS14. Journal of Korean Medical Science. 2011; 26(1):116–23. https://doi.org/10.3346/jkms.2011.26.1.116.

22. Cho SH, Choi MJ, Jeong MH. Metabolic syndrome risk factors related to severity of coronary artery disease in patients with acute myocardial infarction. Journal of Korean Clinical Nursing Research. 2012; 18(1):171–81.

23. Yoo JS, Jeong JI, Park CG, Kang SW, Ahn JA. Impact of life style characteristics on prevalence risk of metabolic syndrome. Journal of Korean Academy of Nursing. 2009; 39(4):594–601. https://doi.org/10.4040/jkan.2009.39.4.594.

24. Son YJ. The development and effects of an integrated symptom management program for prevention of recurrent cardiac events after percutaneous coronary intervention. Journal of Korean Academy of Nursing. 2008; 38(2):217–28. https://doi.org/10.4040/jkan.2008.38.2.217.

25. Kim D, Yoon SJ, Lim DS, Gong YH, Ko S, Lee YH, et al. The preventive effects of lifestyle intervention on the occurrence of diabetes mellitus and acute myocardial infarction in metabolic syndrome. Public health. 2016; 139:178–82. https://doi.org/10.1016/j.puhe.2016.06.012.

26. Nam KH, Kang JY, Lee YJ, Sung SH, Chang YK, Lee JY, et al. Comparison of health outcomes according to intervention compliance in male Korean workers with metabolic syndrome. Korean Journal of Nutrition. 2013; 46(2):156–65. https://doi.org/10.4163/kjn.2013.46.2.156.

27. Blackford K, Jancey J, Lee AH, James A, Howat P, Waddell T. Effects of a home-based intervention on diet and physical activity behaviours for rural adults with or at risk of metabolic syndrome: a randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2016; 13:13. https://doi.org/10.1186/s12966-016-0337-2.

28. Brauer P, Connor Gorber S, Shaw E, Singh H, Bell N, et al. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. Canadian Medical Association Journal. 2015; 187(3):184–95. https://doi.org/10.1503/cmaj.140887.

29. Molloy GJ, Randall G, Wikman A, Perkins-Porras L, Messerli-Bürgy N, Steptoe A. Type D personality, self-efficacy, and medication adherence following an acute coronary syndrome. Psychosomatic Medicine. 2012; 74(1):100–6.

30. Steca P, D’ Addario M, Magrin ME, Miglioretti M, Monzani D, Pancani L, et al. A type A and type D combined personality ty-pology in essential hypertension and acute coronary syndrome patients: associations with demographic, psychological, clinical, and lifestyle Indicators. PLoS One. 2016; 11(9):e0161840. https://doi.org/10.1371/journal.pone.0161840.

Figure 1.

Moderating effect of lifestyle and type-D personality on the relation between metabolic syndrome and severity of coronary artery disease.

Table 1.

Metabolic Syndrome and Severity of Coronary Artery Disease according to Participants' Characteristics (N=111)

Variables	Characteristics	Categories	MS			Severity of CAD
			Yes	No	x² (p)	M± SD	t or F (p)
			n (%)	n (%)	x² (p)	M± SD	t or F (p)
Sociodemographic characteristics	Gender	Men	33 (54.1)	26 (52.0)	0.05	1.41±1.00	1.32
	Gender	Women	28 (45.9)	24 (48.0)	(.826)	1.15±1.02	(.190)
	Age (year)	40~49	8 (13.1)	6 (12.0)	0.23	0.71±0.91	2.32
		50~59	13 (21.3)	12 (24.0)	(.973)	1.16±1.02	(.080)
		60~69	21 (34.4)	18 (36.0)		1.41±0.99
		≥70	19 (31.2)	14 (28.0)		1.48±1.00
	Housemates^†	Yes	52 (85.2)	46 (92.0)	1.21	1.69±0.85	1.54
	Housemates^†	No	9 (14.8)	4 (8.0)	(.271)	1.23±1.02	(.126)
	Economic status	Low	12 (19.7)	7 (14.0)	0.77	1.63±1.11	1.60
		Moderate	30 (49.2)	28 (56.0)	(.679)	1.28±1.03	(.207)
		High	19 (31.1)	15 (30.0)		1.12±0.88
	Job	Yes	35 (57.4)	26 (52.0)	0.32	1.38±1.00	0.86
	Job	No	26 (42.6)	24 (48.0)	(.571)	1.21±1.01	(.390)
	Education^†	≤ Elementary school	12 (19.7)	14 (28.0)	2.19	1.50±1.07	1.44
		Middle school	12 (19.7)	6 (12.0)	(.534)	1.44±1.09	(.441)
		High school	30 (49.2)	26 (52.0)		1.14±0.98
		≥ University	7 (11.4)	4 (8.0)		1.27±0.90
Disease-related characteristics	Family history	Yes	9 (14.8)	9 (18.0)	0.21	1.28±1.01	-0.21
	Family history	No	52 (85.2)	41 (82.0)	(.644)	1.33±1.02	(.838)
	Diagnosis	AP	23 (40.4)	17 (31.5)	0.95	0.40±0.63	-9.78
	Diagnosis	ACS	34 (59.6)	37 (68.5)	(.429)	1.79±0.83	(＜.001)
	Comorbidity	No	10 (18.5)	27 (47.4)	18.63	0.78±0.75	7.58
		1	28 (51.9)	28 (49.1)	(＜.001)	1.55±1.08	(.001)
		2 or more	16 (29.6)	2 (3.5)		1.50±0.92

MS=metabolic syndrome; CAD=coronary artery disease; AP=angina pectoris; ACS=acute coronary syndrome;

^† Fisher exact test.

Table 2.

Degree of Metabolic Syndrome, Lifestyle, Type-D Personality and Severity of Coronary Artery Disease of Participants (N=111)

Variables	Categories	n (%) or M± SD	Actual range	Potential range
Metabolic syndrome	No	50 (45.0)
	Yes	61 (55.0)
		2.86±1.38	0~5.00	0~5.00
	BMI (kg/m²)	25.20±2.87
	Triglyceride (mg/dL)	144.79±99.83
	HDL-cholesterol (mg/dL)	47.01±14.44
	Glucose (mg/dL)	121.29±64.52
	Systolic blood pressure	132.16±21.12
	Diastolic blood pressure	79.01±12.50
Lifestyle		82.41±17.60	64.81~100.01	36~114
Type-D personality	No	79 (71.2)	1.60~13.08	0~28
	Yes	32 (28.8)	1.43~12.71	0~28
	Negative affectivity	7.34±5.74
	Social inhibition,	7.07±5.64
Severity of CAD	0	27 (24.3)	0~3.00	0~3.00
	1	43 (38.7)
	2	23 (20.7)
	3	18 (16.2)
		1.29±1.01

BMI=body mass index; HDL=high density lipoprotein; CAD=coronary artery disease.

Table 3.

Correlation among Metabolic Syndrome, Lifestyle, Type-D Personality and Severity of Coronary Artery Disease (N=111)

Variables	MS	Lifestyle	Type-D personality
Variables	r (p)	r (p)	r (p)
Lifestyle	-.21 (.025)
Type-D personality	.23 (.015)	-.40 (＜.001)
Severity of CAD	.23 (.014)	-.54 (＜.001)	.49 (＜.001)

MS=metabolic syndrome; CAD=coronary artery disease.

Table 4.

Moderating Effects of Lifestyle and Type-D Personality on the Relation between Metabolic Syndrome and Severity of Coronary Artery Disease (N=111)

Variables	B	β	t or F	p	VIF	Moderating effect
(Constant)	1.24	.26	15.44	.001	1.06	Yes
MS	0.30	-.51	1.80	.006	1.06
Lifestyle	-0.03	-.22	-6.24	.001	1.02
MS × Lifestyle	-0.03		-2.55	.001
		Adjusted R²=.33, F=19.18, p＜.001
MS	-	-	2.62	.109	-	No
Type-D personality	-	-	24.77	.001	-
MS × Type-D personality	-	-	0.13	.719	-

MS=metabolic syndrome; VIF=variance inflation factor.

TOOLS

Similar articles