Hostility, depression, and anxiety have been associated with coronary heart disease (CHD), but the role of emotional distress in the development of CHD is still a controversial issue. Evidence shows, however, that emotional distress plays a key role in the progression of CHD: (i) emotional distress is associated with pathophysiological mechanisms and cardiac events in coronary patients, (ii) psychosocial treatments of emotional stress may reduce mortality and morbidity in these patients, and (iii) inhibition of negative emotions may accelerate CHD. Evidence also shows that emotional stress as a risk factor for CHD is a chronic characteristic; research has, however, largely ignored the role of personality in this context. The approach to personality and CHD that is presented in this paper revisits the tradition of global personality traits, and is based on the notion that the interaction between negative affectivity (the tendency to experience negative emotions) and social inhibition (the tendency to inhibit self-expression in social interaction) has potential explanatory power in coronary patients. The construct of type-D personality is introduced to designate those coronary patients who experience difficulties in the areas of negative emotions and self-expression. Type-D patients typically report high levels of depressive symptoms and poor levels of social support. Evidence is presented which suggests that, eventually, the emotional difficulties of type-D patients may result in hard endpoints such as increased risk for long-term mortality. It is concluded that, in addition to assessing specific psychosocial factors, it is equally important to assess the effect of global traits and their interaction on prognosis in patients with CHD.