Submissiveness and protection from coronary heart disease in the general population: Edinburgh Artery Study

Background Type A behaviour and, more specifically, hostility and anger have been associated with increased risk of coronary heart disease (CHD). But less attention has been paid to other features of personality. Our aim was to assess whether a submissiveness trait, which is independent of hostility, was related to future risk of CHD in the general population. Methods The Edinburgh Artery Study is a cohort study of a random sample of 809 men and 783 women aged 55 to 74 years. At the baseline examination in 1988, we administered the Bedford-Foulds Personality Deviance Scales. The participants were followed up for 5 years for cardiovascular events. Criteria to define events were adapted from the American Heart Association. Events were ascertained from the Information and Statistics Division of the Scottish Office Home and Health Department, general practitioners, the UK National Health Service Central Register, annual questionnaires to the participants, and the second examination at the end of follow-up. Findings During follow-up, 57 (7·0%) men and 28 (3·6%) women had non-fatal myocardial infarctions; 25 (3·1%) men and 8 (1·0%) women had fatal myocardial infarctions; and 48 (5·9%) men and 41 (5·2%) women developed angina pectoris. We found that mean submissiveness scores were significantly higher in men and women who did not have a non-fatal myocardial infarction than in those who did (18·88 [SE 0·15] vs 17·70 [0·40], p=0·023 in men; 20·76 [0·17] vs 18·18 [0·86], p=0·002 in women). In multiple logistic-regression models, submissiveness remained independently associated with risk of myocardial infarction in women only; a decreased risk of both non-fatal myocardial infarction (relative risk 0·59 [95% Cl 0·40–0·85]) and, to a lesser extent, total myocardial infarction (0·69 [0·27–0·96]), was associated with an increase of 1 SD in submissiveness. Interpretation The personality trait of submissiveness may be protective against non-fatal myocardial infarction, particularly in women. A better understanding is required of the complicated effects of personality on CHD development.