A prospective study of positive psychological well-being and coronary heart disease.

Abstract

Objective Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle age men and women, and considers potential mediating factors. Methods Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally-adjusted hazard ratios of 0.74 (95% confidence interval: 0.55-0.98) for emotional vitality and 0.73 (95% confidence interval: 0.54-0.99) for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions Positive psychological well-being was associated with a modest but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health.

Is flourishing good for the heart? Relationships between positive psychol characteristics and cardiorespiratory health.[¿Es la salud psicológica buena para el corazón? Relación entre características psicológicas positivas y variables cardiorrespiratorias]

“…Other researchers came to similar conclusions when not finding cardiovascular parameters to mediate between positive psychological well-being and coronary heart disease (Boehm et al, 2011a). The results of the present study suggest that future research should include additional potential mediator factors between flourishing and cardiovascular morbidity, such as ejection fraction, coronary calcification, inflammatory factors, aldosterone, antioxidants and cortisol levels (cf.…”

“…For instance, while in a study of 50 women no connection has been found between positive mood and heart rate variability (Myrtek, Aschenbrenner, & Brügner, 2005), other studies revealed positive associations between positive affect and enhanced parasympathetic cardiac control (Bhattacharyya, Whitehead, Rakhit, & Steptoe, 2008). Results concerning blood pressure are also mixed: while some findings support an inverse association between blood pressure and optimism or life purpose (Mezick et al, 2010;Räikkönen, Matthews, Flory, Owens, & Gump, 1999), other studies failed to verify the mediator role of blood pressure between positive psychological attributes and coronary heart disease (Boehm, Peterson, Kivimaki, & Kubzansky, 2011a;Ryff et al, 2006). Further studies pointed out that positive psychological constructs might also be associated with atherosclerosis and calcification (Matthews, Owens, Edmundowicz, Lee, & Kuller, 2006;Matthews, Räikkönen, Sutton-Tyrrell, & Kuller, 2004).…”

Psychological well-being and psychological distress: is it necessary to measure both?

“…The authors called for more focus on positive emotions as a potential promoting agent for population longevity and health. Boehm et al (2011) report similarly, based on a 5-year follow-up of 7942 participants in the Whitehall II cohort, an association between psychological well-being and a modest but consistent reduction in risk of incident CHD.…”

“…These were: global life satisfaction (3 items), satisfaction with important life domains (your job, your marriage, your children), and positive affect (3 items). Boehm et al (2011) used five items from disparate sources measuring "emotional vitality" plus one assessing optimism. The convergence of results using related but various measuring instruments can be seen as a sign of the robustness of these findings.…”

Socioeconomic status, cognitive-emotional factors, and health status following myocardial infarction: testing the Reserve Capacity Model

“…Although the RCM is a relatively new theoretical framework, aspects of it have been supported with cardiovascular endpoints (e.g., Boehm et al, 2011;Marmot et al, 1997), and with measures of subjective health in national samples (e.g., Vonnelich et al, 2012). For example, Barger (2006) analyzed data from the Midlife in the United States (MIDUS) national survey and confirmed a positive relation between education and subjective health ratings, noting that it was attenuated with inclusion of demographic, behavioral, and clinical factors in the model.…”