Trait impulsivity and risk of cardiovascular disease over 8 years: results from the NutriNet-Santé cohort

Cardiovascular disease (CVD) remains the leading global cause of death, despite being partially preventable. Emerging evidence suggests psychological traits, such as trait impulsivity, may influence disease onset. However, associations between impulsivity and CVD remain understudied. This study investigates associations between trait impulsivity and CVD incidence. We conducted a prospective analysis within the French NutriNet-Santé cohort between May 2014 (time of impulsivity assessment) and February 2023, including adults aged ≥ 18 years without prevalent CVD. Data were collected via a web-based platform. Trait impulsivity was assessed using the Barratt Impulsiveness Scale 11 and categorized as low, moderate (reference), or high. Incident CVD events, including coronary heart disease and cerebrovascular disease, were identified through follow-up assessments and confirmed by NutriNet-Santé experts using medical records. Multivariable Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (HR [95%CI]). Potential interactions, such as prevalence of type 2 diabetes (T2D), were assessed. Among 48,135 participants (78.1% women; mean age: 50.5 ± 14.5 years), 1,184 developed CVD over a median follow-up period of 7.84 years (IQR: 4.04-8.50). High impulsivity was associated with increased CVD risk (HR = 1.27 [1.01, 1.59], P = 0.039), compared to moderate impulsivity. Among participants with T2D (n = 1,301), low impulsivity was associated with reduced CVD risk (HR = 0.42 [0.20, 0.88], P = 0.022); no such association was observed in those without T2D (P for interaction = 0.014). Higher trait impulsivity was associated with greater CVD risk, while lower impulsivity exhibited protection in individuals with T2D. Trait impulsivity may represent a relevant psychological risk factor for CVD and could inform prevention strategies.