Association Between Optimism and Incident Stroke Among Stroke Survivors: Findings From the English Longitudinal Study of Ageing

Abstract

Abstract Background Personality has been implicated in stroke death. However, the role of personality in stroke incidence is unclear. Purpose Our primary aim was to investigate associations between optimism, determination, control, and the “Big Five” personality traits on incident stroke. A secondary aim was to assess the potential mediating role of health behaviors in the personality-stroke relationship. Methods A total of 3,703 stroke-free participants from the English Longitudinal Study of Ageing provided data on personality using the Midlife Development Inventory at Wave 5 (2010/11). Self-reported incident stroke was assessed from Waves 6 to 8 (2012–2017). Associations were modeled using discrete-time survival proportional odds logistic models. Analyses were adjusted for sociodemographic factors, history of other cardiometabolic diseases, and health behaviors. Results Over 6 years follow-up there were 125 incident strokes. Higher optimism (hazard ratio [HR] = 0.66; 95% confidence interval [CI] 0.53, 0.82), openness (HR = 0.72; 95% CI 0.53, 0.98), and conscientiousness (HR = 0.59; 95% CI 0.42, 0.84) were associated with reduced incident stroke risk in unadjusted models. After adjustment for sociodemographic factors and history of cardiometabolic disease, only the association between optimism and incident stroke remained significant (HR = 0.72; 95% CI 0.57, 0.92). The effect of optimism remained significant in a final model adjusting for health behaviors (HR = 0.75; 95% CI 0.60, 0.96). There was evidence of a small but significant mediating effect of physical activity. Conclusions Higher trait optimism was associated with reduced stroke risk. This association was partially mediated by physical activity albeit the effect was small, and caution warranted inferring causality. The interplay of personality, behavior, and clinical risk factors in stroke incidence and survivorship needs further investigation.