Neuroticism, Worry, and Cardiometabolic Risk Trajectories: Findings From a 40-Year Study of Men

Abstract

Background Anxiety is linked to elevated risk of cardiometabolic disease onset, but the underlying mechanisms remain unclear. We examined the prospective association of 2 anxiety facets, neuroticism and worry, with cardiometabolic risk (CMR) trajectories for 4 decades. Methods and Results The sample comprised 1561 men from an ongoing adult male cohort. In 1975, healthy men (mean age, 53 years [SD, 8.4 years]) completed the Eysenck Personality Inventory-Short Form neuroticism scale and a Worries Scale. Seven CMR biomarkers were assessed every 3 to 5 years. The CMR score was the number of biomarkers categorized as high-risk based on established cut points or medication use. Using mixed effects regression, we modeled CMR trajectories over age and evaluated their associations with neuroticism and worry. Using Cox regression, we examined associations of neuroticism and worry with risk of having ≥6 CMR high-risk biomarkers through 2015. CMR increased at 0.8 markers per decade from age 33 to 65 years, at which point men had an average of 3.8 high-risk markers, followed by a slower increase of 0.5 markers per decade. Higher neuroticism (B=0.08; 95% CI, 0.02-0.15) and worry levels (B=0.07; 95% CI, 0.001-0.13) were associated with elevated CMR across time, and with 13% (95% CI, 1.03-1.23) and 10% (95% CI, 1.01-1.20) greater risks, respectively, of having ≥6 high-risk CMR markers, adjusting for potential confounders. Conclusions By middle adulthood, higher anxiety levels are associated with stable differences in CMR that are maintained into older ages. Anxious individuals may experience deteriorations in cardiometabolic health earlier in life and remain on a stable trajectory of heightened risk into older ages.

Keywords: aging; anxiety; cardiometabolic risk; neuroticism; prospective study.

Figure 1. Hypothetical models of cardiometabolic risk (CMR) trajectories by neuroticism levels.

(A) Depicts a model in which higher neuroticism brings about a steeper increase in CMR among all ages. (B) Reflects a model in which neuroticism primarily affects CMR in early life. According to this model, more vs less neurotic individuals show a steeper increase in CMR early in life and thereafter have worse CMR at all points in later adulthood, but the pace of change in CMR throughout adulthood is similar for both groups. Therefore, group differences in CMR as assessed in adulthood manifest as parallel lines in (B), as opposed to widening trajectories in (A). The shaded area represents ages unobserved for the current sample; nonetheless, examining their CMR trajectories in midlife and old age is useful for testing differing hypotheses regarding the pathogenetic timing of risk associated with neuroticism and worry for CMR.

Figure 2. Estimated trajectory of high‐risk cardiometabolic markers by neuroticism terciles (top) and a median split in total worry score (bottom).