Optimism & Better Cardiovascular Health
Rosalba Hernandez and colleagues from the University of Illinois at Urbana–Champaign, IL recently reported a link between optimism and cardiovascular health, derived from a large, ethnically and racially diverse population study, being perhaps the first in this field.
In general, the study suggests that people who have upbeat outlooks on life have significantly better cardiovascular health.
Begun in 2000, the Multi-Ethnic Study of Atherosclerosis (MESA) included 6,000 people from six U.S. regions, followed participants for 11 years, and cardiovascular health was assessed using seven metrics, the same metrics used by the American Heart Association (AHA) to define heart health.
Participants’ cardiovascular health was assessed using seven metrics: blood pressure, body mass index, fasting plasma glucose and serum cholesterol levels, dietary intake, physical activity and tobacco use – the same metrics used by the American Heart Association to define heart health and being targeted by the AHA in its Life’s Simple 7 public awareness campaign.
The study reports that individuals’ total health scores are proportional to their levels of optimism, and “people who were the most optimistic were 50 and 76 percent more likely to have total health scores in the intermediate or ideal ranges, respectively”.
The association between optimism and cardiovascular health was even stronger when socio-demographic characteristics such as age, race and ethnicity, income and education status were factored in. People who were the most optimistic were twice as likely to have ideal cardiovascular health, and 55 percent more likely to have a total health score in the intermediate range, the researchers found.
“Individuals with the highest levels of optimism have twice the odds of being in ideal cardiovascular health compared to their more pessimistic counterparts,” said lead author Rosalba Hernandez, a professor of social work at the University of Illinois. “This association remains significant, even after adjusting for socio-demographic characteristics and poor mental health.”
These results suggest that “prevention strategies that target modification of psychological well-being may be a potential avenue for AHA to reach its goal of improving Americans’ cardiovascular health by 20 percent before 2020.”
An Update
A novel approach to promoting cardiovascular health can draw from research on optimism, which has been identified as a modifiable, upstream psychological resource that is related to improved cardiovascular outcomes.
In 2018, Julia K. Boehm et al. conducted random effects meta-analyses examining optimism’s association with 3 health behaviors relevant for the prevention of cardiovascular disease; and identified 34 effect sizes for physical activity (n=90 845), 15 effect sizes for diet (n=47 931), and 15 effect sizes for cigarette smoking (n=15 052).
Result: Evidence from the meta-analyses reported here suggests that optimism is modestly associated with greater physical activity, eating healthier food, and being less likely to smoke cigarettes in both healthy and patient populations. It does not seem that optimists ignore future health because of a rosy outlook; instead, they engage in healthier behaviors compared with their less optimistic peers.
In 2021, Hermioni L. Amonoo et al. concluded: Optimism, independent of sociodemographic, medical, and negative psychological factors, has been prospectively associated with a lower risk of cardiovascular disease and lower rates of cardiac and all-cause mortality. The mechanisms by which optimism may prevent cardiovascular disease remain unclear, but one mechanism may be through health behaviors.
A 2021 Systematic Review and Meta-Analysis by Chayakrit Krittanawong MD et al. published in the The American Journal of Medicine found that optimism was associated with lower rates of all-cause mortality and cardiovascular events. These results are consistent with prior meta-analysis founding that higher levels of optimism were associated with a 35% decrease in risk of incident cardiovascular disease events.
The authors concluded: ‘In this pooled meta-analysis, optimism was associated with a reduced risk of all-cause mortality and of cardiovascular disease. These results suggest an important relationship between psychological health and cardiovascular disease that may serve as an area for intervention by clinicians’.
Of note, as per these authors, The American Heart Association statement from 2021 also suggested consideration of psychological health in the evaluation and management of patients with, or at risk for, cardiovascular disease. In fact, lack of optimism could relate to higher rates of clinical depression—which is ultimately related to poorer cardiovascular health.
