Optimism linked to lower risk of cardiac events and all-cause mortality

Having an optimistic mindset is linked to a lower risk of cardiac events and all-cause mortality, according to new research from the Icahn School of Medicine at Mount Sinai. The research, published in the September 27 issue of JAMA Network Open, could create a new target for preventive health and new behavioral interventions for cardiac patients.

While the last 30 years has established a link between heart disease and several psychological factors, such as depression and loneliness, only recently have investigators begun to zero in on the medical importance of mindsets, such as optimism versus pessimism. Optimism has long been linked to better performance in school and in such jobs as sales, sports, political endeavors, and social relationships, but it's also an important health issue that has not been well studied until now."

Alan Rozanski, MD, Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, and Director of Nuclear Cardiology and Cardiac Stress Testing and Chief Academic Officer for the Department of Cardiology at Mount Sinai St. Luke's

In this study, a team of researchers conducted a comprehensive meta-analysis of all published medical studies since the inception of reported bio behavioral research (PubMed, Scopus and PsycInfo) that investigated the association between optimism and pessimism, and the subsequent occurrence of cardiovascular events and/or all-cause mortality. They looked at 15 medical studies, nearly all community-based, involving approximately 230,000 patients.

Many of the analyzed studies incorporated a now-highly validated "Life Orientation Test," which asks individuals to answer six standard questions regarding thoughts about their future. Examples included: "In uncertain times I usually expect the best," "I am always optimistic about my future," or "I hardly expect things to go my way." The analysis made adjustment for important clinical factors such as depression and physical activity, which are also known risk factors for heart disease.

Overall, the investigators found that those with optimism had a 35 percent reduction in risk of cardiovascular events (heart attack, stroke, and cardiac death) when compared to the pessimistic subjects in the study. The results were highly robust, with optimism associated with substantially lower risk in 9 of the 10 medical studies that examined cardiac events. The results also remained significant after adjustment for co-occurring depression, physical activity level, gender, and education (risk factors for disease). Also, similar results were obtained among studies performed in the United States and abroad.

The authors also noted a proportional "dose-response" relationship between the amount of optimism and clinical outcomes: the higher the level of optimism, the lower the risk for cardiac events or death.

The current work could spur investigations into the biological mechanisms by which optimism promotes health and pessimism promotes illness. Along these lines, the authors cite emerging data that links optimism to better metabolic health and a lower risk of inflammation. In addition, optimism is associated with better health habits, such as exercise and healthy diets, whereas pessimism is associated with poorer health habits and a greater likelihood of smoking. Dr. Rozanski observes that these data are consistent with evidence "that optimists have better life skills and coping mechanisms, including a greater tendency to adopt pro-active behaviors which ward off future problems. Pro-active health habits appear to be part of this."

"The new research represents a growing trend that seeks to merge positive psychology with health promotion in the medical world. Until now, positive psychology has been primarily studied by behavioral specialists, but this study suggests that treating pessimism and fostering optimistic thinking may be well suited for various types of medical encounters, such as the conduct of cardiac rehabilitation programs. Such programs seek to help patients adopt better health habits and deal with mental and emotional challenges while recovering from life-altering heart attacks, strokes, heart failure, or coronary bypass surgery," explains Dr. Rozanski. He goes to add, "No one size fits all in treating pessimism, but various promising approaches have been identified, including teaching pessimistic patients better coping skills and helping them to learn how to recognize automatic pessimistic thoughts, which then can be challenged through reframing techniques, a commonly employed strategy in cognitive behavioral therapy."

Further research will need to assess whether optimism that is enhanced or induced through directed prevention or intervention strategies has similar health benefits versus optimism that is naturally occurring. The current findings about optimism and cardiac benefits may also lead to future studies on the health benefits of other positive mindsets, such as a sense of purpose and gratitude that may be gained through guided interventions.