SUBMISSIVENESS AND PROTECTION FROM CORONARY HEART-DISEASE IN THE GENERAL-POPULATION - EDINBURGH ARTERY STUDY

Background Type A behaviour and, more specifically, hostility and ange r have been associated with increased risk of coronary heart disease ( CHD). But less attention has been paid to other features of personalit y. Our aim was to assess whether a submissiveness trait, which is inde pendent 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 ba seline examination in 1988, we administered the Bedford-Foulds Persona lity Deviance Scales. The participants were followed up for 5 years fo r cardiovascular events. Criteria to define events were adapted from t he American Heart Association. Events were ascertained from the Inform ation and Statistics Division of the Scottish Office Home and Health D epartment, general practitioners, the UK National Health Service Centr al 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 th at mean submissiveness scores were significantly higher in men and wom en who did not have a non-fatal myocardial infarction than in those wh o did (18.88 [SE 0.15] vs 17.70 [0.40], p=0.023 in men; 20.76 [0.17] v s 18.18 [0.86], p=0.002 in women). In multiple logistic-regression mod els, submissiveness remained independently associated with risk of myo cardial infarction in women only; a decreased risk of both non-fatal m yocardial 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 as sociated with an increase of 1 SD in submissiveness. Interpretation Th e personality trait of submissiveness may be protective against non-fa tal myocardial infarction, particularly in women. A better understandi ng is required of the complicated effects of personality on CHD develo pment.