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Personality traits and the risk of coronary heart disease or stroke in women with diabetes – an epidemiological study based on the Women's Health Initiative

Miao Jonasson, Junmei MD, PhD1; Hendryx, Michael PhD2; Manson, JoAnn E. MD, DrPH3; Dinh, Paul MPH4; Garcia, Lorena MPH, DrPH5; Liu, Simin PhD6; Luo, Juhua PhD4

doi: 10.1097/GME.0000000000001382
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Objective: We studied the associations between personality traits and the risk of coronary heart disease (CHD) or stroke in women with diabetes.

Methods: From the Women's Health Initiative, 15,029 women aged 50 to 79 years at enrollment and with self-reported treated diabetes at baseline or follow-up, were followed for a mean of 10 years. Personality traits measured from validated scales included hostility, optimism, ambivalence over emotional expressiveness, and negative emotional expressiveness. Multivariable Cox proportional-hazards regression models were used to examine associations between personality traits and the risk of adjudicated CHD (nonfatal myocardial infarction and CHD death) or stroke outcomes. Progressively adjusted regression approach was used in the multivariable models to adjust for demographics, depression, anthropometric variables, and lifestyle factors.

Results: A total of 1,118 incident CHD and 710 incident stroke cases were observed. Women in the highest quartile of hostility had 22% (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.01-1.48) increased risk for CHD compared with women in the lowest quartile of hostility. P values for trend were greater than 0.05. Stratified analysis by prevalent or incident diabetes showed that the highest quartile of hostility had 34% increased risk for CHD (HR 1.34, 95% CI 1.03-1.74) among women with incident diabetes. Other personality traits were not significantly associated with stroke or CHD.

Conclusions: Hostility was associated with incidence of CHD among postmenopausal women with diabetes, especially among incident diabetes. These results provide a basis for targeted prevention programs for women with a high level of hostility and diabetes.

1Department of Public Health and Community Medicine at Institute of Medicine Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden

2Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, IN

3Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

4Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN

5Department of Public Health Sciences, School of Medicine University of California – Davis, CA

6School of Public Health, Brown University, Providence, RI.

Address correspondence to: Junmei Miao Jonasson, MD, PhD, Associate Professor, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. E-mail: junmei.jonasson@gu.se

Received 27 March, 2019

Revised 28 May, 2019

Accepted 28 May, 2019

Author contributions: J.M.J conceived and designed the study; acquired, managed, analyzed, and interpreted data; and drafted the manuscript and revised the manuscript. J.L. and M.H. conceived and designed the study; interpreted data; and critically reviewed and revised the manuscript. J.E.M., P.D., L.G., and S.L. interpreted data and critically reviewed and revised the manuscript. J.M.J. and J.L. are the guarantors of this work, and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding/support: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

Financial disclosure/conflicts of interest: None declared.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.menopause.org).

Online date: August 30, 2019

© 2019 by The North American Menopause Society.