According to Dr. Denollet, what most likely links poor health outcomes to the type D personality subtype is the distinctly high level of stress associated with it. Unlike other personality types who like to vent, type Ds social inhibition leaves them with no such outlet for their stress. This pent-up stress causes high cortisol levels, which, in turn, can lead to high blood pressure as well as chronic, artery-damaging inflammation. It is worth noting that another possible explanation for this correlation is that type Ds likely also suffer from depression, anxiety, and poor social connections, each of which has been linked with poor health and heart disease.