If you relate more to downtrodden, withdrawn Eeyore than to upbeat, spunky Piglet in the Winnie-the-Pooh cartoons, you may have a harder time recovering from any heart problems, according to a new review of heart health studies.

The findings don't mean that people should try to change who they are, said study researcher Johan Denollet, a medical psychology professor at Tilburg University in the Netherlands. But the results highlight the importance of behavioral therapies in addition to traditional treatments for heart disease, he said.

People with Type D personalities are often anxious, irritable, pessimistic and secretive when it comes to sharing feelings, Denollet said. These traits aren't known to cause cardiovascular problems, but the review shows that patients who have heart disease and a Type D personality are less likely to benefit from treatments and may be more likely than people of other personality types to have further heart problems after an initial episode.

"A lot of these people keep these emotions built up for a long time, in addition to chronic stress, which can be harmful to the cardiovascular system,"  Denollet told MyHealthNewsDaily. In part, that's because stress can lead to bad habits like smoking and a sedentary lifestyle, he added.

Type D personalities also may be more likely than others to have elevated blood pressure or chronic inflammation, because they may have an overactive immune system or may be less communicative with their doctor about their health problems, he said.

The new study reviewed the results of 49 previous studies, involving more than 6,000 patients, that examined heart and psychological health, Denollet said. Patients were determined to have a Type D personality based on their answers to a 14-question survey that asked if they agreed with statements such as "I am a closed kind of person" and "I often feel unhappy."

People with Type D personalities had a risk three times higher than the average heart patient of having future cardiovascular problems such as peripheral artery disease, heart failure and heart attack, Denollet said. They also had an increased risk of needing a bypass or a heart transplant.

"It's a fairly large increase," he said.

While some characteristics of Type D personalities that are similar to those of people with depression, only about 25 percent of people surveyed in the studies classified as both a Type D personality and having depression, Denollet said.

"Depression  is more an emotional disorder, whereas Type D is in essence a normal personality trait," he said.

The idea of classifying personality types arose in the 1970s, said Barry J. Jacobs, a clinical psychologist with the American Heart Association. The Type A personality is the competitive, hostile, compulsive person. Type B represents people who are laid-back, easygoing and not particularly driven.

Although early research associated Type A personalities with heart disease, most of those theories were later debunked, Jacobs said. However, the Type D personality type, which was first recognized in the 1990s, includes many aspects of the Type A personality that were believed to be conducive to heart problems, he said.

The new study makes a strong case for considering an individual's personality in cardiovascular disease prevention, in treating disease that's already developed and in preventing further complications, said Jacobs, who was not involved with the study review. Cardiologists may need to get a sense of their patient's personalities and talk with them about how their tendencies could have an impact on their health.

"It's not just enough to give patients cholesterol medications or put in stents, and it may not even be enough to have them jog and eat better," Jacobs said.

The study was published Tuesday (Sept. 14) in the journal Circulation: Cardiovascular Quality and Outcomes.

This article was provided by MyHealthNewsDaily, a sister site to LiveScience.