Journal of Behavioral Medicine

, Volume 37, Issue 5, pp 881–889

Personality traits as risk factors for stroke and coronary heart disease mortality: pooled analysis of three cohort studies

  • Markus Jokela
  • Laura Pulkki-Råback
  • Marko Elovainio
  • Mika Kivimäki


We examined whether personality traits are differently associated with coronary heart disease and stroke mortality. Participants were pooled from three prospective cohort studies (Health and Retirement Study, Wisconsin Longitudinal Study graduate and sibling samples; n = 24,543 men and women, mean age 61.4 years, mortality follow-up between 3 and 15 years). There were 423 coronary heart disease deaths and 88 stroke deaths during 212,542 person-years at risk. Higher extraversion was associated with an increased risk of stroke (hazard ratio per each standard deviation increase in personality trait HR = 1.41, 95 % CI 1.10–1.80) but not with coronary heart disease mortality (HR = 0.93, 0.83–1.05). High neuroticism, in turn, was more strongly related to the risk of coronary heart disease (HR = 1.16, 1.04–1.29) than stroke deaths (HR = 0.95, 0.78–1.17). High conscientiousness was associated with lower mortality risk from both coronary heart disease (HR = 0.74, 0.67–0.81) and stroke (HR = 0.78, 0.63–0.97). Cardiovascular risk associated with personality traits appears to vary between main cardiac and cerebral disease endpoints.


Personality Stroke Coronary heart disease Meta-analysis 

Supplementary material

10865_2013_9548_MOESM1_ESM.pdf (173 kb)
Supplementary material 1 (PDF 172 kb)


  1. Almada, S. J., Zonderman, A. B., Shekelle, R. B., Dyer, A. R., Daviglus, M. L., Costa, P. T. J., et al. (1991). Neuroticism and cynicism and risk of death in middle-aged men: the Western Electric Study. Psychosomatic Medicine, 53, 165–175.PubMedCrossRefGoogle Scholar
  2. Baigent, C., Keech, A., Kearney, P. M., Blackwell, L., Buck, G., Pollicino, C., et al. (2005). Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet, 366, 1267–1278.PubMedCrossRefGoogle Scholar
  3. Boehm, J. K., & Kubzansky, L. D. (2012). The heart’s content: The association between positive psychological well-being and cardiovascular health. Psychological Bulletin, 138, 655–659.PubMedCrossRefGoogle Scholar
  4. Bogg, T., & Roberts, B. W. (2004). Conscientiousness and health-related behaviors: A meta-analysis of the leading behavioral contributors to mortality. Psychological Bulletin, 130, 887–919.PubMedCrossRefGoogle Scholar
  5. Booth-Kewley, S., & Friedman, H. S. (1987). Psychological predictors of heart disease: a quantitative review. Psychological Bulletin, 101, 343–362.PubMedCrossRefGoogle Scholar
  6. Brook, R. D., & Julius, S. (2000). Autonomic imbalance, hypertension, and cardiovascular risk. American Journal of Hypertension, 13, 112S–122S.PubMedCrossRefGoogle Scholar
  7. Burke, J. F., Stulc, J. L., Skolarus, L. E., Sears, E. D., Zahuranec, D. B., & Morgenstern, L. B. (2013). Traumatic brain injury may be an independent risk factor for stroke. Neurology, 81, 33–39.PubMedCentralPubMedCrossRefGoogle Scholar
  8. Chen, Y. H., Kang, J. H., & Lin, H. C. (2011). Patients with traumatic brain injury: population-based study suggests increased risk of stroke. Stroke, 42, 2733–2739.PubMedCrossRefGoogle Scholar
  9. Chida, Y., & Steptoe, A. (2008). Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosomatic Medicine, 70, 741–756.PubMedCrossRefGoogle Scholar
  10. Clarke, S., & Robertson, I. (2005). A meta-analytic review of the Big Five personality factors and accident involvement in occupational and non-occupational settings. Journal of Occupational and Organizational Psychology, 78, 355–376.CrossRefGoogle Scholar
  11. Connor-Smith, J. K., & Flachsbart, C. (2007). Relations between personality and coping: A meta-analysis. Journal of Personality and Social Psychology, 93, 1080–1107.PubMedCrossRefGoogle Scholar
  12. Deary, I. J., Weiss, A., & Batty, G. D. (2010). Intelligence and personality as predictors of illness and death: How researchers in differential psychology and chronic disease epidemiology are collaborating to understand and address health inequalities. Psychological Science in the Public Interest, 11, 53–79.CrossRefGoogle Scholar
  13. Depue, R. A., & Collins, P. F. (1999). Neurobiology of the structure of personality: Dopamine, facilitation of incentive motivation, and extraversion. Behavioral & Brain Sciences, 22, 491–517.Google Scholar
  14. Goldstein, L. B., Bushnell, C. D., Adams, R. J., Appel, L. J., Braun, L. T., Chaturvedi, S., et al. (2011). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42, 517–584.PubMedCrossRefGoogle Scholar
  15. Hauser, R. M., Sewell, W. H., & Clarridge, B. R. (1982). The influence of family structure on socioeconomic achievement: A progress report. CDE Working Paper No. 82-59.Google Scholar
  16. Hill, P. L., & Roberts, B. W. (2011). The role of adherence in the relationship between conscientiousness and perceived health. Health Psychology, 30, 797–804.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Houston, B. K., Babyak, M. A., Chesney, M. A., Black, G., & Ragland, D. R. (1997). Social dominance and 22-year all-cause mortality in men. Psychosomatic Medicine, 59, 5–12.PubMedCrossRefGoogle Scholar
  18. John, O. P., Naumann, L. P., & Soto, C. J. (2008). Paradigm shift to the integrative big-five trait taxonomy: History, measurement, and conceptual issues. In O. P. John, R. W. Robins, & L. A. Pervin (Eds.), Handbook of personality: Theory and research (pp. 114–158). New York, NY: Guilford Press.Google Scholar
  19. Jokela, M., Batty, G. D., Deary, I. J., Silventoinen, K., & Kivimäki, M. (2011). Sibling analysis of adolescent intelligence and chronic diseases in older adulthood. Annals of Epidemiology, 21, 489–496.PubMedCrossRefGoogle Scholar
  20. Jokela, M., Batty, G. D., Nyberg, S. T., Virtanen, M., Nabi, H., Singh-Manoux, A., et al. (2013a). Personality and all-cause mortality: Individual-participant meta-analysis of 3,947 deaths in 76,150 adults. American Journal of Epidemiology, 178, 667–675.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Jokela, M., Elovainio, M., Nyberg, S. T., Tabak, A. G., Hintsa, T., Batty, G. D. et al. (in press). Personality and risk of diabetes in adults: Pooled analysis of 5 cohort studies. Health Psychology.Google Scholar
  22. Jokela, M., Hintsanen, M., Hakulinen, C., Batty, G. D., Nabi, H., Singh-Manoux, A., et al. (2013b). Association of personality with the development and persistence of obesity: A meta-analysis based on individual-participant data. Obesity Reviews, 14, 315–323.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Jokela, M., Power, C., & Kivimäki, M. (2009). Childhood problem behaviors and injury risk over the life course. Journal of Child Psychology and Psychiatry, 50, 1541–1549.PubMedCrossRefGoogle Scholar
  24. Jonassaint, C. R. M. A., Boyle, S. H. P., Williams, R. B. M. D., Mark, D. B. M. D., Siegler, I. C. P. M. P. H., & Barefoot, J. C. P. (2007). Facets of openness predict mortality in patients with cardiac disease. Psychosomatic Medicine, 69, 319–322.PubMedCrossRefGoogle Scholar
  25. Juster, F. T., & Suzman, R. (1995). An overview of the Health and Retirement Study. Journal of Human Resources, 30, S7–S56.CrossRefGoogle Scholar
  26. Kivimäki, M., Nyberg, S. T., Batty, G. D., Fransson, E. I., Heikkila, K., Alfredsson, L., et al. (2012). Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data. Lancet, 380, 1491–1497.PubMedCentralPubMedCrossRefGoogle Scholar
  27. Kubzansky, L. D., & Kawachi, I. (2000). Going to the heart of the matter-do negative emotions cause coronary heart disease? Journal of Psychosomatic Research, 48, 323–338.PubMedCrossRefGoogle Scholar
  28. Kung, H. C., Hoyert, D. L., Xu, J. Q., & Murphy, S. L. (2008). Deaths: Final data for 2005. National Vital Statistics Reports, 56. Google Scholar
  29. Lachman, M. E., & Weaver, S. L. (1997). The Midlife Development Inventory (MIDI) personality scales: Scale construction and scoring. MA: Waltham.Google Scholar
  30. Lodi-Smith, J., Jackson, J., Bogg, T., Walton, K., Wood, D., Harms, P., et al. (2010). Mechanisms of health: Education and health-related behaviours partially mediate the relationship between conscientiousness and self-reported physical health. Psychology & Health, 25, 305–319.CrossRefGoogle Scholar
  31. Manuck, S. B., Marsland, A. L., Kaplan, J. R., & Williams, J. K. (1995). The pathogenicity of behavior and its neuroendocrine mediation: an example from coronary artery disease. Psychosomatic Medicine, 57, 275–283.PubMedCrossRefGoogle Scholar
  32. Martin, L. R., Friedman, H. S., & Schwartz, J. E. (2007). Personality and mortality risk across the life span: The importance of conscientiousness as a biopsychosocial attribute. Health Psychology, 26, 428–436.PubMedCrossRefGoogle Scholar
  33. McCaffrey, J. M., Frasure-Smith, N., Dubé, M. P., Théroux, P., Rouleau, G. A., Duan, Q., et al. (2006). Common genetic vulnerability to depressive symptoms and coronary artery disease: A review and development of candidate genes related to inflammation and serotonin. Psychosomatic Medicine, 68, 187–200.CrossRefGoogle Scholar
  34. McCarron, P., Gunnell, D., Harrison, G. L., Okasha, M., & Smith, G. D. (2003). Temperament in Young adulthood and later morality: prospective observational study. Journal of Epidemiology and Community Health, 57, 888–892.PubMedCentralPubMedCrossRefGoogle Scholar
  35. Nakaya, N., Tsubono, Y., Hosokawa, T., Hozawa, A., Kuriyama, S., Fukudo, S., et al. (2005). Personality and mortality from ischemic heart disease and stroke. Clinical and Experimental Hypertension, 27, 297–305.PubMedCrossRefGoogle Scholar
  36. Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Z., Verschuren, M., et al. (2012). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). European Heart Journal, 33, 1635–1701.PubMedCrossRefGoogle Scholar
  37. Puddu, P., Puddu, G. M., Bastagli, L., Massarelli, G., & Muscari, A. (1995). Coronary and cerebrovascular atherosclerosis: two aspects of the same disease or two different pathologies? Archives of Gerontology and Geriatrics, 20, 15–22.PubMedCrossRefGoogle Scholar
  38. Rothwell, P. M., Howard, S. C., Dolan, E., O’Brien, E., Dobson, J. E., Dahlof, B., et al. (2010). Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet, 375, 895–905.PubMedCrossRefGoogle Scholar
  39. Schwebel, D. C., & Plumert, J. M. (1999). Longitudinal and concurrent relations among temperament, ability estimation, and injury proneness. Child Development, 70, 700–712.PubMedCrossRefGoogle Scholar
  40. Shipley, B. A., Weiss, A., Der, G., Taylor, M. D., & Deary, I. J. (2007). Neuroticism, extraversion, and mortality in the UK Health and Lifestyle Survey: A 21-year prospective cohort study. Psychosomatic Medicine, 69, 923–931.PubMedCrossRefGoogle Scholar
  41. Siegman, A. W., Kubzansky, L. D., Kawachi, I., Boyle, S., Vokonas, P. S., & Sparrow, D. (2000). A prospective study of dominance and coronary heart disease in the Normative Aging Study. American Journal of Cardiology, 86, 145–149.PubMedCrossRefGoogle Scholar
  42. Smith, T. W., Allred, K. D., Morrison, C. A., & Carlson, S. D. (1989). Cardiovascular reactivity and interpersonal influence: Active coping in a social context. Journal of Personality and Social Psychology, 56, 209–218.PubMedCrossRefGoogle Scholar
  43. Smith, T. W., & MacKenzie, J. (2006). Personality and risk of physical illness. Annual Review of Clinical Psychology, 2, 435–467.PubMedCrossRefGoogle Scholar
  44. Steptoe, A., & Chida, Y. (2009). The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. Journal of the American College of Cardiology, 53, 936–946.PubMedCrossRefGoogle Scholar
  45. Steptoe, A., Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21, 901–912.PubMedCrossRefGoogle Scholar
  46. Steptoe, A., & Kivimäki, M. (2012). Stress and cardiovascular disease. Nature Reveiw Cardiology, 9, 360–370.CrossRefGoogle Scholar
  47. Steptoe, A., & Kivimäki, M. (2013). Stress and cardiovascular disease: an update on current knowledge. Annual Review of Public Health, 34, 337–354.PubMedCrossRefGoogle Scholar
  48. Terracciano, A., Lockenhoff, C. E., Zonderman, A. B., Ferrucci, L., & Costa, P. T. (2008). Personality predictors of longevity: Activity, emotional stability, and conscientiousness. Psychosomatic Medicine, 70, 621–627.PubMedCentralPubMedCrossRefGoogle Scholar
  49. Terracciano, A., Sutin, A. R., McCrae, R. R., Deiana, B., Ferrucci, L., Schlessinger, D., et al. (2009). Facets of personality linked to underweight and overweight. Psychosomatic Medicine, 71, 682–689.PubMedCentralPubMedCrossRefGoogle Scholar
  50. Traupman, E. K., Smith, T. W., Uchino, B. N., Berg, C. A., Trobst, K. K., & Costa, P. T, Jr. (2009). Interpersonal circumplex octant, control, and affiliation scales for the NEO-PI-R. Personality and Individual Differences, 47, 457–463.CrossRefGoogle Scholar
  51. Vollrath, M., Landolt, M. A., & Ribi, K. (2003). Personality of children with accident-related injuries. European Journal of Personality, 17, 299–307.CrossRefGoogle Scholar
  52. Watson, D., & Clark, L. A. (1992). On traits and temperament: General and specific factors of emotional experience and their relation to the 5-factor model. Journal of Personality, 60, 441–476.PubMedCrossRefGoogle Scholar
  53. Watson, D., & Hubbard, B. (1996). Adaptational style and dispositional structure: Coping in the context of the five-factor model. Journal of Personality, 64, 737–774.CrossRefGoogle Scholar
  54. Weiss, A., & Costa, P. T. (2005). Domain and facet personality predictors of all-cause mortality among medicare patients aged 65 to 100. Psychosomatic Medicine, 67, 724–733.PubMedCrossRefGoogle Scholar
  55. Wilhelmsen, L., Koster, M., Harmsen, P., & Lappas, G. (2005). Differences between coronary disease and stroke in incidence, case fatality, and risk factors, but few differences in risk factors for fatal and non-fatal events. European Heart Journal, 26, 1916–1922.PubMedCrossRefGoogle Scholar
  56. Wollmering, E. (Ed.). (2007). Wisconsin Longitudinal Study Handbook (12.10.07). Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Markus Jokela
    • 1
    • 2
  • Laura Pulkki-Råback
    • 1
  • Marko Elovainio
    • 3
  • Mika Kivimäki
    • 4
  1. 1.Institute of Behavioural SciencesUniversity of HelsinkiHelsinkiFinland
  2. 2.Department of PsychologyUniversity of CambridgeCambridgeUK
  3. 3.National Institute of Health and WelfareHelsinkiFinland
  4. 4.Research Department of Epidemiology and Public HealthUniversity College LondonLondonUK

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