Associations Between a General Factor and Group Factor from the Spanish-Language Eysenck Personality Questionnaire-Revised Short Form's Neuroticism Scale and the Revised NEO Personality Inventory Domains and Facets.

Prior studies used exploratory bifactor analyses to examine the structure of the Neuroticism scale from the Short-scale Eysenck Personality Questionnaire-Revised (EPQ-RS). These studies revealed a general factor and two group factors-Anxious-Tense and Worried-Vulnerable. These factors were related to poorer mental health, but their associations with physical health differed, as did their genetic and neurobiological underpinnings. A later study found that their associations with the Big Five Inventory-2 Short Form's factors and facets differed. We reanalyzed data on 1,006 Spanish students who completed Spanish-language versions of the EPQ-RS and the Revised NEO Personality Inventory (NEO PI-R). Using confirmatory factor analysis, we showed that a model comprising the general factor and a group factor-Anxious-Tense-fit well. In later correlations, a joint factor analysis, and simultaneous multiple regressions, we showed that the EPQ-RS's general factor and the group factor had different patterns of associations with the NEO PI-R domains and facets. These associations were consistent with the definition of the EPQ-RS Neuroticism scale's general factor and that of the group factor. Further investigation into the EPQ-RS Neuroticism scale's structure can improve our understanding of neuroticism's relationship with health and other outcomes.

Prefrontal activity during IOWA Gambling Task in young adult women.

This study aims to investigate the relationships between personality traits of impulsivity, using the UPPS-P Impulsive Behaviour Scales shortened version, and prefrontal cortex (PFC) activity during the IOWA Gambling Task (IGT) in young adult women. The study included a sample of 83 young, healthy females (19.8 ± 1.4 years), who voluntarily took part in the study. Repeated measures analysis during the IGT revealed a significant increase in HbO (all p <.001; ηp2 >.31) and a decrease in Hbr (all p <.003; ηp2 >.08) in all prefrontal quadrants. This increase in oxygenation occurs primarily during the choice period under ambiguity (r =.23; p =.039). Additionally, there was a significant linear decrease in selecting the decks associated with a high frequency of losses (p <.001), while the favorable deck with low losses showed a linear increase (F = 12.96; p <.001). Notably, discrepancies were found between UPPS-P and IGT impulsivity ratings. The Lack of Perseverance and Lack of Premeditation scales from the UPPS-P were identified as significant predictors of HbO levels, mainly in the two quadrants of the left hemisphere's, lateral (adjusted R2 =.23; p <.001; f2 =.34) and rostral (adjusted R2 =.13; p <.002; f2 =.17). These findings suggest that young adult women predominantly adopt a punishment-avoidance strategy during IGT, exhibiting increased activation in the left hemisphere, especially during the task's initial phase characterized by ambiguity.

The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future.

The Alternative Model of Personality Disorders (AMPD) is a dimensional, empirically based diagnostic system developed to overcome the serious limitations of traditional categories. We review the mounting evidence on its convergent and discriminant validity, with an incursion into the less-studied ICD-11 system. In the literature, the AMPD's Pathological Trait Model (Criterion B) shows excellent convergence with normal personality traits, and it could be useful as an organizing framework for mental disorders. In contrast, Personality Functioning (Criterion A) cannot be distinguished from personality traits, lacks both discriminant and incremental validity, and has a shaky theoretical background. We offer some suggestions with a view to the future. These include removing Criterion A, using the real-life consequences of traits as indicators of severity, delving into the dynamic mechanisms underlying traits, and furthering the integration of currently disengaged psychological paradigms that can shape a sounder clinical science. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Psychological predictors of risky driving: the role of age, gender, personality traits (Zuckerman's and Gray's models), and decision-making styles.

The present study was planned to study the relationships between age, personality (according to Zuckerman's and Gray's psychobiological models) and decision-making styles in relation to risky driving behaviors. The participants were habitual drivers, 538 (54.3%) men and 453 (45.7%) women, with a mean age around 45 years and mainly of middle socioeconomic status. The results indicate that the youngest men and women reported more Lapses, Ordinary violations, and Aggressive violations than the oldest men and women. Women reported more Lapses (d = -0.40), and men more Ordinary (d = 0.33) and Aggressive violations (d = 0.28) when driving. Linear and non-linear analysis clearly support the role of both personality traits and decision-making styles in risky driving behaviors. Aggressiveness, Sensitivity to Reward, Sensation Seeking played the main role from personality traits, and Spontaneous and Rational decision-making style also accounted for some variance regarding risky driving behaviors. This pattern was broadly replicated in both genders. The discussion section analyses congruencies with previous literature and makes recommendations on the grounds of observed results.

Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11).

The inclusion of the borderline pattern in the International Classification of Diseases, 11th Revision (ICD-11) dimensional classification of personality disorders (PDs) has caused controversy. Unease about leaving out these clinically challenging patients seems to conflict with the need of an evidence-based and credible diagnostic system. However, the accommodation of borderline within the new diagnostic system has not yet been studied in depth. To this end, we examine in a sample of 1799 general population and clinical subjects the joint structure of the five initial ICD-11 domains and the borderline pattern. Regression and item-level factor analyses reveal that borderline criteria do not form a separate construct and are indissociable from negative affectivity. Furthermore, borderline adds nothing to the remaining domains when it comes to predict PD severity. The borderline pattern appears as largely superfluous and even misguiding, unless their criteria are properly integrated within the structure of personality pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Construct Validity of the Dutch, English, French, and Spanish LPFS-BF 2.0: Measurement Invariance Across Language and Gender and Criterion Validity.

With the introduction of the Alternative Model of Personality Disorders in the DSM-5, the need for short measures of the level of personality functioning has emerged, both for screening purposes and for assessing change during treatment. The Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) was constructed for this and has received support for its two-factor structure and criterion validity. The authors aimed to provide additional construct validity evidence for the LPFS-BF 2.0 by examining its factor structure and measurement invariance across the Dutch, English, French, and Spanish versions and across gender, and its criterion validity. Results showed that the two-factor model had a good fit to the data in the four linguistic versions. Configural and metric invariance were supported across linguistic versions and gender, while scalar invariance was partially supported. Reporting a mental health disorder and having consulted with a mental health professional were associated with higher LPFS-BF 2.0 scores.

Factor Convergence and Predictive Analysis of the Five Factor and Alternative Five Factor Personality Models with the Five-Factor Personality Inventory for ICD-11 (FFICD).

The authors analyze and compare the factor convergence and predictive power of the Revised NEO Personality Inventory (NEO-PI-R) and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ/SF) with respect to the Five-Factor Personality Inventory for ICD-11 (FFiCD). A total of 803 White Spanish subjects were analyzed. All the personality domains had significant predictive power with regard to the FFiCD except NEO Openness. The explained variance of the personality domains with respect to FFiCD Negative Affectivity (71% and 77%) and Detachment (56% and 56%) were similar for NEO-PI-R and ZKA-PQ/SF, respectively, but the NEO-PI-R accounted for greater variance for FFiCD Anankastia, Dissociality, and Disinhibition. The FFiCD facets of Rashness, Thrill- Seeking (Disinhibition), and Unassertiveness (Detachment) were located in factors other than those theoretically expected. The authors conclude that normal personality measured by the NEO-PI-R and the ZKA-PQ/SF contribute, in a differential but complementary way, to knowledge of the maladaptive personality measured by the FFiCD.

Locating the Dark Triad in a Multidimensional Personality Space.

The Dark Triad traits of Psychopathy, Machiavellianism, and Narcissism should be clearly recognizable within a multidimensional personality space. Two such personality spaces were investigated in this study: HEXACO (Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, and Openness to Experience); and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ) space (Extraversion, Neuroticism, Activity, Sensation Seeking, and Aggressiveness). Our sample comprised 289 participants (137 males, 145 females, 7 unspecified) who completed these three questionnaires: HEXACO-60, ZKA-PQ/SF, and the SD3, assessing the Dark Triad. We reduced the dimensionality of each space to that of a 2D representation using Smallest Space Analysis (SSA). Three research questions guided the data analysis: (a) Do the HEXACO and ZKA-PQ SSA spaces conform to the structure of a radex? (b) Will these spaces remain invariant following the entry of the Dark Triad traits into the analyses? (c) Where will the Dark Triad traits be located in each SSA space? For ZKA-PQ space, the structure was clearly indicative of a radex, both prior to entering the Dark Triad traits into the analysis, and subsequent to this. Psychopathy and Machiavellianism were in close proximity in the Aggressiveness region; Narcissism was positioned at the common origin. In contrast, HEXACO space did not conform to a radex; furthermore, the presence of the Dark Triad traits distorts this 2D SSA space.

High convergent validity among the five-factor model, PID-5-SF, and PiCD.

In the last 10 years, 2 instruments (the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PID-5] and the Personality Inventory for International Classification of Diseases, 11th Revision [PiCD]) have been developed to measure the dimensional approach to personality disorders (PDs). Several studies have analyzed the relationships between both instruments and the five-factor model, although the PiCD has received less attention than the PID-5, given its more recent publication. For instance, the PiCD has never been related to the Revised NEO Personality Inventory (NEO-PI-R). The aims of the present article were to explore the convergent validity of the NEO-PI-R, a short version of the PID-5 (PID-5-SF), and the PiCD, to compare these dimensional approaches as for their ability to predict categorical PDs measured through the screening questionnaire of the International Personality Disorder Examination and to explore the nature of 2 controversial pathological domains: Psychoticism (from the PID-5-SF) and Anankastia (from the PiCD). A total of 1,565 people from the Spanish general population completed the NEO-PI-R, PID-5-SF, and PiCD. A total of 758 also filled out the International Personality Disorder Examination. Results show a high convergent validity of the five-factor model, the PID-5-SF, and the PiCD. Especially relevant from a clinical perspective is the great convergence between the 2 measures of dimensional PDs. In light of the results, the personality correlates of Psychoticism are reconsidered, and the location of Anankastia as the opposite pole of Disinhibition instead of as a separate domain, suggested by previous authors, is supported. The advantages of a dimensional approach to PDs and the practical implications for their assessment are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factor Convergence and Predictive Analysis of the Five Factor and Alternative Five Factor Personality Models With the Five-Factor Personality Inventory for ICD-11 (FFiCD).

The authors analyze and compare the factor convergence and predictive power of the Revised NEO Personality Inventory (NEO-PI-R) and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ/SF) with respect to the Five-Factor Personality Inventory for ICD-11 (FFiCD). A total of 803 White Spanish subjects were analyzed. All the personality domains had significant predictive power with regard to the FFiCD except NEO Openness. The explained variance of the personality domains with respect to FFiCD Negative Affectivity (71% and 77%) and Detachment (56% and 56%) were similar for NEO-PI-R and ZKA-PQ/SF, respectively, but the NEO-PI-R accounted for greater variance for FFiCD Anankastia, Dissociality, and Disinhibition. The FFiCD facets of Rashness, Thrill- Seeking (Disinhibition), and Unassertiveness (Detachment) were located in factors other than those theoretically expected. The authors conclude that normal personality measured by the NEO-PI-R and the ZKA-PQ/SF contribute, in a differential but complementary way, to knowledge of the maladaptive personality measured by the FFiCD.

Locating the Dark Triad in a Multidimensional Personality Space

The Dark Triad traits of Psychopathy, Machiavellianism, and Narcissism should be clearly recognizable within a multidimensional personality space. Two such personality spaces were investigated in this study: HEXACO (Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, and Openness to Experience); and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ) space (Extraversion, Neuroticism, Activity, Sensation Seeking, and Aggressiveness). Our sample comprised 289 participants (137 males, 145 females, 7 unspecified) who completed these three questionnaires: HEXACO–60, ZKA-PQ/SF, and the SD3, assessing the Dark Triad. We reduced the dimensionality of each space to that of a 2D representation using Smallest Space Analysis (SSA). Three research questions guided the data analysis: (a) Do the HEXACO and ZKA-PQ SSA spaces conform to the structure of a radex? (b) Will these spaces remain invariant following the entry of the Dark Triad traits into the analyses? (c) Where will the Dark Triad traits be located in each SSA space? For ZKA-PQ space, the structure was clearly indicative of a radex, both prior to entering the Dark Triad traits into the analysis, and subsequent to this. Psychopathy and Machiavellianism were in close proximity in the Aggressiveness region; Narcissism was positioned at the common origin. In contrast, HEXACO space did not conform to a radex; furthermore, the presence of the Dark Triad traits distorts this 2D SSA space. (AU)

Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample.

Severity is the main component of the ICD-11 personality disorder (PD) classification, but pertinent instruments have only recently been developed. We analyzed the psychometric properties of the ICD-11 Personality Disorder Severity scale (PDS-ICD-11) in a mixed sample of 726 community and clinical subjects. We also examined how the different components of the ICD-11 PD system -five trait domains, the borderline pattern specifier, and severity, all of them measured through self-reports- are interconnected and operate together. PDS-ICD-11 properties were adequate and similar to those of the original instrument. However, regressions and factor analyses showed a considerable overlap of severity with the five personality domains and the borderline specifier (72.6%). Bifactor modeling resulted in a general factor of PD (g-PD) that was not equivalent to severity nor improved criterion validity. The whole ICD-11 PD system, i.e., five personality domains, borderline, and severity, explained an average of 43.6% of variance of external measures of well-being, disability, and clinical problems, with severity contributing 4.8%. Suggestions to further improve the ICD-11 PD taxonomy include remodeling the present definition of severity to give more weight to the real-life consequences of traits.

Psychometric properties of the Five-Factor Personality Inventory for ICD-11 (FFiCD) in Spanish community samples.

At present, there are two models of pathological personality represented in two measurement instruments, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD). Although both instruments have shown high convergence, the PID-5 has the advantage of including facets that might offer greater predictive capacity. An alternative to the PiCD has recently been proposed to overcome this drawback, namely the Five-Factor Personality Inventory for ICD-11 (FFiCD). The present study aims to explore its internal structure and to offer additional validity evidence. Data were collected for a total of 1,409 community individuals from two populations in Spain. They responded to the FFiCD, PiCD, the PID-5/SF, and measures of personality functioning and personality disorder screening (Level of Personality Functioning Scale Self-Report [LPFS-SR] and International Personality Disorder Examination [IPDE]). The internal structure of the FFiCD was analyzed through exploratory factor analysis with oblique and bifactor rotations. The predictive capacity of the domains and facets was examined. The structure reported in the original study was replicated, as were the convergent validity data with respect to the PID-5/SF and the PiCD. Facets were grouped into four factors corresponding to the theoretical domains, including a bipolar Anankastia/Disinhibition factor. High correlations were found with the LPFS-SR, and the patterns of relationships with the IPDE shed light on which aspects of pathological personality contribute most to the 10 traditional personality disorders. In general, validity evidence is provided to support the use of the FFiCD, though four of the 20 facets merit revision so that a simpler factor structure can be obtained. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring the stability of HEXACO-60 structure and the association of gender, age, and social position with personality traits across 18 countries.

OBJECTIVES: The present paper tests the cross-national stability of the HEXACO-60 structure across 18 countries from four continents. Gender and age differences across countries will be examined. Finally, this is the first study to explicitly analyze the relationships between the HEXACO and social position. METHOD: Ten thousand two hundred and ninety eight subjects (5,410 women and 4,888 men) from 18 countries and 13 languages were analyzed. Confirmatory factor analysis techniques were used to test configural, metric and scalar invariance models. Congruence coefficients with the original structure of the HEXACO-60 were computed for every culture. Effect sizes of gender, age, and social position factors across countries were also computed. RESULTS: HEXACO-60 demonstrates configural and metric invariance, but not scalar invariance. Congruence coefficients show a great equivalence in almost all countries and factors. Only Emotionality presents a large gender difference across countries. No relevant effect of age is observed. A profile of high scores on Honesty-Humility, Extraversion, Conscientiousness, and Openness to Experience, and low scores on Emotionality increases the likelihood of achieving a higher social position, although the effect sizes are small. CONCLUSIONS: HEXACO-60 is a useful instrument to conduct personality trait research and practice around the world. Implications of gender, social position, and country differences are discussed.

Decision-Making and the Alternative Five Factor Personality Model: Exploring the Role of Personality Traits, Age, Sex and Social Position.

This study explores the relationship between decision-making style, as measured by the Melbourne Decision Making Questionnaire, and personality based on alternative five-factor model along with effect of age, sex and social position on such styles. A large sample of community and undergraduate students (n = 1,562; Mage = 40.03, SD = 18.43) was analyzed. The results showed that Neuroticism and Extraversion were significantly related to the non-vigilant styles Hypervigilance, Buck-passing and Procrastination. Women scored significantly lower in Vigilance and higher in Hypervigilance, Buck-passing and Procrastinations than men. Age was significantly related to decision-making style in a U-shaped fashion. The Social Position Index was significantly related to all decision-making styles. The most predictive personality domains regarding decision-making scales were Aggressiveness (negatively) and Activity for Vigilance, and Neuroticism for Hypervigilance, Buck-passing and Procrastination. Age, sex and social position had a small/medium overall effect on the four dimensions of Melbourne Decision Making Questionnaire (p < 0.001) with a η2 of 0.038, 0.068, 0.050, and 0.031 for Vigilance, Hypervigilance, Buck-passing and Procrastination, respectively. Based on scores on a single factor dimension of the MDMQ, the profile of participants with higher scores was characterized by lower age, more likely to be females, lower social position, higher levels of Aggressiveness, less Activity, less Extraversion, and higher Neuroticism.

A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire.

Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.

Location of International Classification of Diseases-11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, dimensional trait models in the alternative five-factor personality space.

This study explores the dimensionality (factor analysis) and the relationships (empirical networks) between the Zuckerman alternative five-factor personality model and the two current pathological dimensional personality systems based on the International Classification of Diseases-11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Section III. To this end, the Zuckerman-Kuhlman-Aluja Personality Questionnaire-Short Form (ZKA-PQ/SF), the Personality Inventory for ICD-11, and the Personality Inventory for DSM-5-Short Form were used with 1,229 healthy community subjects: 578 men (Mage = 40.03, SD = 17.77) and 651 women (Mage = 39.63, SD = 17.81). The results show that the pathological traits of Negative Affectivity, Detachment, Disinhibition, and Antagonism/Dissociality are correlatively placed in the Neuroticism, Extraversion, Sensation Seeking, and Aggressiveness dimensional space. Psychoticism is positioned, to a lesser extent and with a similar loading, in Sensation Seeking and Neuroticism, whereas Anankastia is associated with the Activity factor. The five ZKA-PQ domains explain 42% of the variance of Personality Inventory for ICD-11 and 39% of the variance of Personality Inventory for DSM-5-Short Form, whereas the ZKA-PQ facets explain 47% and 44%, respectively. It is concluded that Zuckerman's alternative five-factor model of personality may be useful to better understand the position of pathological or maladaptive traits in the space of normal personality, complementarily to the five-factor model. It also helps to integrate the maladaptive personality traits of the ICD-11 and the DSM-5 Section III into a single system. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model.

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample.

The International Classification of Diseases-11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition-anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.

Biological correlates of the Toronto Alexithymia Scale (TAS-20) in cardiovascular disease and healthy community subjects.

This research studies the relationship between Alexithymia, behavioural, biometric, biochemical and cardiovascular risk in clinical and healthy samples. There were 602 participants (mean age of 52.82 ± 10.59) divided into two groups. The first was made up of 202 patients (165 males and 37 females) who had suffered a cardiovascular disease (CVD), while the second was composed of 400 (285 males and 115 females) healthy volunteers without CVD diagnosis. A cardiovascular risk index (CRI) was developed with the high factorial loading of the following variables: systolic and diastolic blood pressure, total cholesterol/HDL, triglycerides, body mass index, glucose and alcohol and tobacco consumption. The results showed a significant correlation between Alexithymia and the CRI. After controlling for age, sex, occupation, alcohol and tobacco consumption, this correlation decreased, but remained significant for most values. Alexithymia predicted 6% of CRI in the entire sample, once age and sex effect were discounted. Alexithymic subjects with scores above a cut-off point set at higher than 60 had higher levels of glucose, systolic, diastolic, cholesterol/HDL and cardiovascular risk. We discuss that Alexithymia scores contribute to cardiovascular risk, supporting previous findings.