Lower levels of care linked to higher risk of cardiovascular disease in type 2 diabetes

People with type 2 diabetes who show less diligence may be at a significantly higher risk of developing cardiovascular disease, with which diabetes is strongly linked, according to research published in the open-access journal BMJ Open Diabetes Research and Care.

While certain personality traits may influence cardiovascular disease risk, the findings show that adopting a healthy lifestyle is still beneficial regardless of level of commitment.

For effective treatment of type 2 diabetes, it is important to maintain a healthy lifestyle and follow a strict medication schedule. The influence of personality traits on the risk of cardiovascular disease may therefore be significant, the researchers suggest.

To investigate this further, they followed the health of 8,794 people with type 2 diabetes who took part in the UK Biobank study between 2006 and 2010, until the end of 2021.

The participants’ personality and psychological makeup were assessed using the Big Five traits: extraversion; agreeableness; conscientiousness; openness and neuroticism.

Because the UK Biobank study does not collect data on direct measures of these traits, proxies were created using self-reported information on mental health, psychological factors, and social support. These proxies were sociability, warmth, industriousness, curiosity, and nervousness.

During an average monitoring period of approximately 13 years, 2110 individuals developed cardiovascular disease.

Diligence was associated with a significantly lower risk of developing any form of cardiovascular disease, even after accounting for potentially influential factors. People who exhibited this trait were 7% less likely to experience a cardiovascular event during the tracking period.

In addition, the risk of a heart attack was 10% lower, the risk of a stroke caused by a blood clot (ischemic stroke) was 17% lower, the risk of atrial fibrillation (irregular heart rhythm) was 8% lower and the risk of heart failure was 16% lower.

They were also more likely to have healthy lifestyle habits than those who did not. But regardless of level of commitment, those with healthy lifestyle behaviors had better cardiovascular outcomes than those with unhealthy lifestyle behaviors.

Diligence is a proxy for conscientiousness and is characterized by resourceful, disciplined and organized behavior, which is expressed in various traits such as orderliness and diligence. Previously published studies have suggested that people with this trait are less likely to smoke and more likely to be physically active, the researchers explain.

This is an observational study and as such cannot establish cause and effect. The researchers also acknowledge several limitations to their findings. For example, psychological factors, such as depression and anxiety, are known to be associated with cardiovascular disease, but their role could not be comprehensively evaluated in this study.

And there was no information available on potentially influential lifestyle factors, such as alcohol consumption, diet and sleep patterns, or on adherence to medication. Participants in the UK Biobank study are also predominantly white, so the findings may not apply to other ethnicities.

Nevertheless, the researchers conclude: “Among the personality traits, lower levels of diligence were significantly associated with a higher risk of cardiovascular disease, including myocardial infarction. [heart attack]ischemic stroke, atrial fibrillation and heart failure in patients with type 2 diabetes.”

They add: “Unhealthy lifestyle behaviors were more common in patients with low than high commitment scores. However, healthy lifestyle factors had a protective association with cardiovascular disease in both groups of patients.

“These findings highlight the importance of assessing personality traits for predicting cardiovascular risk and modifying lifestyle factors as preventive strategies for patients with type 2 diabetes.”