Positive psychological well‐being and cardiovascular disease: Exploring mechanistic and developmental pathways

Abstract

Empirical research regarding the health benefits of positive psychological well‐being (e.g., positive emotions, life satisfaction, purpose in life, and optimism) has flourished in recent years, particularly with regard to cardiovascular disease. This paper reviews the state of evidence for well‐being's association with cardiovascular disease in both healthy individuals and those diagnosed with a disease. Prospective studies consistently indicate well‐being reduces cardiovascular events in healthy and, to a lesser extent, patient populations. Potential pathways that link well‐being with cardiovascular disease are discussed (including health behaviors, physiological processes, and stress buffering), although the existing evidence is mostly cross‐sectional which limits conclusions about directionality. Issues related to development across the lifespan are considered and childhood is identified as a crucial period for establishing healthy cardiovascular trajectories. Outstanding questions for future research are provided with recommendations to focus on well‐powered and prospective study designs with rigorous assessment of both well‐being and cardiovascular‐related outcomes.

Why does purpose in life predict mortality in older adults?

“…That is, at longer horizons (e.g., years 8-12), many individuals suffering from poor health One concern is that the smaller sample available in the final period means the tests are underpowered to identify the relation between purpose and longevity (although the 2006 health metrics continue to predict long-term survival). Inconsistent with this explanation, however, when the sample is limited to individuals with both 2006 and 2014 data, 2014 purpose is strongly related to 2014-2018 mortality (HR, 1•94: 95% CI, 1•23-3•07), but 2006 purpose is not (HR, 0•90: 95% CI, 0•48-1•69, see appendix pp [14][15][16]. This means that either changes in health substantially impact purpose (reverse causation), or changes in purpose have strong near-term health impacts but purpose levels do not impact mortality risk.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Given the overwhelming evidence, recent work focuses on understanding how higher purpose causes greater longevity via behavioral pathways (e.g., higher purpose might cause healthier eating, greater use of preventive health care, or greater exercise), biological pathways (e.g., greater purpose might cause better lipid profiles, lower blood pressure, or a lesser likelihood of developing diabetes), and psychological stress-buffering pathways (e.g., greater purpose might cause individuals to react less strongly to stressors). [14][15][16][17][18][19][20][21][22][23][24] As recent studies point out, this evidence is exciting because it represents a potential low-cost lever-life purpose intervention-to improve health and longevity. 1,3,10,14,16,17,25 Causality, however, is the key remaining question as another potential interpretation of the evidence is that, by definition, poorer baseline health causes increased mortality risk, but could also cause lower life purpose.…”

“…[14][15][16][17][18][19][20][21][22][23][24] As recent studies point out, this evidence is exciting because it represents a potential low-cost lever-life purpose intervention-to improve health and longevity. 1,3,10,14,16,17,25 Causality, however, is the key remaining question as another potential interpretation of the evidence is that, by definition, poorer baseline health causes increased mortality risk, but could also cause lower life purpose. [14][15][16][17]26 That is, causation may run primarily from health to purpose rather than from purpose to health.…”

“…1,3,10,14,16,17,25 Causality, however, is the key remaining question as another potential interpretation of the evidence is that, by definition, poorer baseline health causes increased mortality risk, but could also cause lower life purpose. [14][15][16][17]26 That is, causation may run primarily from health to purpose rather than from purpose to health. Following suggestions in recent surveys, 15,17 we adopt a two-pronged approach to examining causality by (1) using more comprehensive measures of current health, and (2) evaluating a longer follow-up period.…”

Health shocks and changes in life purpose: Understanding the link between purpose and longevity

“…Previous work finds that higher levels of purpose in life are associated with lower future illness and mortality and proposes that life purpose intervention may offer a promising low-cost opportunity to improve health and longevity. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] A 2016 meta-analysis, for example, reports that higher life purpose is associated with a relative risk of 0•83 for both all-cause mortality (p<0•001) and cardiovascular events (p<0•001). 17 Although the evidence is promising, causation is less clear as the link between purpose and mortality may arise because: (1) low purpose causes decreased health and increased mortality risk, (2) a decline in health causes increased mortality risk and lower purpose (i.e., reverse causation), or (3) both paths contribute (although not necessarily equally) to the relation between purpose and subsequent morbidity and mortality.…”