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Neuroticism and sudden cardiac death: a prospective cohort study from UK biobank

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Abstract

Objective

There is a paucity of evidence on the risk of sudden cardiac death (SCD) according to the degree of neuroticism. We sought to evaluate the association between neuroticism and the long-term risk of SCD.

Methods

From the UK Biobank nationwide prospective cohort, participants free from previous SCD, ventricular arrhythmias, implantable cardioverter-defibrillator (ICD) insertion, depression, schizophrenia, and bipolar disorder were selected. The 12-item scale of neuroticism measurement (neuroticism score) was categorized into high (≥ 3) and low (< 3) groups. The primary outcome was SCD including ventricular fibrillation (VF) at median 12.6 years of follow-up. The outcomes were compared between the groups using multivariable Cox regression and inverse probability of treatment weighting (IPTW).

Results

A total of 377,563 participants (aged 56.5 ± 8.1, 53.1% women) were analyzed. The high neuroticism score group had a significantly lower risk of SCD (adjusted hazard ratio [aHR] = 0.87, 95% confidence interval [CI] 0.79–0.96, P = 0.007; IPTW-adjusted HR [IPTW-HR] 0.87 [0.77–0.97], P = 0.016) than the low neuroticism score group. The effect of a high neuroticism score on the decreased risk of SCD was more prominent in women (IPTW-HR 0.71 [0.56–0.89], P = 0.003) than in men (IPTW-HR 0.93 [0.82–1.07], P = 0.305, P-for-interaction = 0.043). Sex differences were observed among independent predictors for incident SCD, emphasizing the protective role of a high neuroticism score and moderate-to-vigorous physical activity only in women.

Conclusions

A high neuroticism score was significantly associated with a lower risk of SCD, particularly in women. Efforts to unveil the causal and mechanistic relationship between personality phenotypes and the risk of SCD should be continued.

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Data availability

All data used in this study are publically available from the UK Biobank (https://biobank.ndph.ox.ac.uk/).

Abbreviations

ASD:

Absolute standardized difference

aHR:

Adjusted hazard ratio

CAD:

Coronary artery disease

CI:

Confidence interval

EPQ-N:

The revised Eysenck Personality Questionnaire

ICD:

Implantable cardioverter-defibrillator

IPTW:

Inverse probability of treatment weighting

MI:

Myocardial infarction

MVPA:

Moderate-to-vigorous physical activity

SCD:

Sudden cardiac death

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

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Acknowledgements

Dr. Eue-Keun Choi 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

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Tae-Min Rhee and Kyung-Yeon Lee contributed equally to this works.

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea

    Tae-Min Rhee, Kyung-Yeon Lee, JungMin Choi, Eue-Keun Choi, Hyo-Jeong Ahn, So-Ryoung Lee & Seil Oh

  2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea

    Eue-Keun Choi, So-Ryoung Lee, Seil Oh & Gregory Y. H. Lip

  3. Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Chest and Heart Hospital, Liverpool, UK

    Gregory Y. H. Lip

  4. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gregory Y. H. Lip

Authors
  1. Tae-Min Rhee
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  2. Kyung-Yeon Lee
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Contributions

T-MR played a role in the conceptualization of the study, data management, creation of graphs, and writing of the initial draft. K-YL contributed to the initial draft writing, manuscript review, and editing. JMC, H-JA, S-RL, and SO were involved in the conceptualization and manuscript review. GYHL participated in the manuscript review and editing. E-KC contributed to the conceptualization, manuscript review, editing, and provided supervision. The final approval for manuscript submission was given by E-KC. All authors have thoroughly reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Eue-Keun Choi.

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Rhee, TM., Lee, KY., Choi, J. et al. Neuroticism and sudden cardiac death: a prospective cohort study from UK biobank. Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02289-y

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