Joint Associations of Type D Personality and Allostatic Load With Coronary Artery Disease in Type 2 Diabetes: Evaluating the Role of Allostatic Load.

Journal: Biopsychosocial science and medicine
Published Date: Dec 2, 2025

Abstract

OBJECTIVE: This study aimed to (1) evaluate and compare the independent associations and predictive strength of type D personality and allostatic load (AL) against traditional risk factors for coronary artery disease (CAD) in patients with type 2 diabetes (T2DM), (2) explore the potential mediating role of AL in the association between type D personality and CAD, and (3) investigate their joint effect on CAD risk. METHODS: This cross-sectional study included 1089 patients with diabetes (aged 45 years or more). Type D personality was assessed using the type D scale-14. The AL index comprised 10 biomarkers from cardiovascular, metabolic, and immune systems, selected based on established criteria. RESULTS: Among 1089 patients, 305 (28.0%) had CAD. The XGBoost machine learning model identified both AL and type D personality as factors exhibiting stronger associations with CAD prevalence than most traditional cardiovascular risk factors. Furthermore, mediation analysis revealed a significant indirect effect, suggesting that AL accounted for 16.67% of the observed association between type D personality and CAD. Regarding their combined impact, compared with the reference group (non-type D+low AL), adjusted odds ratios for CAD were 1.68 (95% CI = 1.12-2.52) for type D alone, 1.87 (95% CI = 1.33-2.63) for high AL alone, and 2.74 (95% CI = 1.77-4.25) for both factors combined. CONCLUSIONS: AL partially explained the type D-CAD association, and their co-occurrence conferred the highest CAD risk, suggesting potential utility for combined risk stratification.

Authors

  • Lin Liu
    Institute of Natural Sciences, MOE-LSC, School of Mathematical Sciences, CMA-Shanghai, SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University; Shanghai Artificial Intelligence Laboratory.
  • Ting Han
    Key Laboratory of Chem-Biosensing, Anhui province, Key Laboratory of Functional Molecular Solids, Anhui province, College of Chemistry and Materials Science, Center for Nano Science and Technology, Anhui Normal University, Wuhu 241000, P. R. China. [email protected].
  • Qingfang Ye
  • Yining Wang
    Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
  • Ping Lin
    Department of Geriatrics, The Third Hospital of Hangzhou, Hangzhou, Zhejiang, China.

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