August 20th, 2010

A “Good” Heart…

John Mandrola, an electrophysiologist and avid cyclist, usually writes about cycling in the Wednesday posts to his blog, Dr. John. Here he examines how antagonism relates to carotid thickness.

This Wednesday, it will be easy to combine cycling and medicine.

When I saw this study that linked antagonistic personality traits and cardiovascular risk, it was simply impossible to ignore, especially on a Wednesday. Low hanging fruit, no doubt.

It was an NIH sponsored study that looked at the effects of antagonistic traits, low agreeableness specifically, on heart health. Yes, you read it right, agreeableness. To quantify agreeableness, these researchers used a personality questionnaire that evaluated six traits: trust, straightforwardness, altruism, compliance, modesty, and my favorite, tender-mindedness.

Your hypothesis is probably right: people who were distrustful, cynical, manipulative, self-centered, and quick to express anger fared worse. Don’t worry cyclists, these are not your traits. Ha! Wink.

Please do not dismiss this as just another mundane study proclaiming the risks of an angry personality. The specifics of the findings and their implications hit really hard.

The researchers studied 5600 patients from Sardinia, Italy.  They used carotid artery thickness as a surrogate measure of vascular health. (Obviously, a thicker vessel wall is worse.  Also, on average, men have thicker-walled carotid arteries than women.)   There were four striking findings:

  • Low agreeableness scores were associated with thicker-walled arteries and an increased likelihood of progressive thickening over a three-year span.
  • The effects of poor agreeableness scores were more pronounced in women. So much so that the artery thickness of women with really low agreeableness scores was the same as in men. In other words, being a highly disagreeable woman may transform the favorable female artery to resemble the less desirable state in men. (I am not making this up.)
  • Straightforwardness and compliance were the specific traits that correlated most with artery wall thickness.
  • The wake-up-and-pay-attention take-home message is that the increased CV risk of antagonistic traits is similar in magnitude to the risks of high cholesterol, high blood pressure, and even smoking. Statistically speaking, being disagreeable was as bad as being a smoker, or having high blood pressure or high cholesterol.

There are caveats here. This is a population-based study, not a randomized, prospective trial. Also, it evaluated a select population in one area of Italy. Finally, this study used a surrogate endpoint for heart disease, rather than hard endpoints, such as heart attack and stroke.

Nonetheless, I predict that in the future, the health of the “spiritual” heart will be scientifically linked with the health of the “biologic” heart.  And this link will likely be where the “rubber meets the road,” where the platelets hit the vessel wall, the endothelium.  At least when it comes to inflammation and heart health, Gramps may have been wrong when he frequently said, “nice guys finish last.”

Eat well, sleep well, move a lot, and now, be agreeable, straightforward, and even tender-minded, should be the advice of doctors to patients who wish to minimize their cardiac risk profile.

Cyclists, you have no need to worry, I can vouch for your tender-mindedness.


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