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.
Graphical abstract
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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.
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This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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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.
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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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DOI: https://doi.org/10.1007/s00392-023-02289-y