If you’re the kind of person who lives life seeing the glass “half-full,” a new heart study has good news for you. (As if there’s any other kind of news, right?) The meta-analysis, published September 27, 2019, in JAMA Network Open, found optimism is associated with a lower risk of cardiovascular events like heart attack and stroke, as well as early death.
“The data was very robust,” says lead study author Alan Rozanski, MD, a researcher at the Icahn School of Medicine at Mount Sinai in New York City. Although the association doesn’t necessarily prove that attitude caused the reduced risk, the data did show a proportional relationship, says Dr. Rozanski. “The more optimistic the person was, the more their risk of heart attack, stroke, or early death was lowered,” he says.
These findings are something cardiologists often see anecdotally in treating patients, says Luke Laffin, MD, a cardiologist at Cleveland Clinic in Ohio. “Adopting a positive outlook is good advice, no matter if it’s for cardiovascular events or all-cause mortality. If we had the manpower to look at how this might affect a variety of medical conditions, I think we’d see that people who are optimistic tend to do better across multiple fronts — not just heart events,” says Dr. Laffin.
How the Researchers Established the Association
To examine possible associations between optimism and the risk of cardiovascular events and overall death, this observational meta-analysis examined 229,391 participants from 15 different studies that took place between 2001 and 2017. Of those, 14 studies were prospective — meaning the participants were watched over the study period for a particular outcome — and one was a retrospective cohort study — meaning the participants had all experienced the outcome (such as a heart attack), and the researchers then looked for risk factors that might have caused or contributed to it.
The included studies used a variety of different screening methods to determine the level of optimism, including the Minnesota Multiphasic Personality Inventory (MMPI) and the Life Orientation Test-Revised (LOT-R).
Participants were followed for cardiac events or death for an average of 14 years. The people in the study who were rated the most optimistic by their responses to the diagnostic tools were 35 percent less likely than the least optimistic people to have a heart attack or stroke, and 14 percent less likely to die for any reason.
There were a few limitations in the analysis. Ages of the participants varied; although many studies were limited to older people, a few included individuals in their thirties or forties. The researchers didn’t control for smoking, diabetes, or high blood pressure, which would likely influence cardiovascular events or early death.
Researchers excluded people with clinical depression, which is different than pessimism and could have confounded the results, says Laffin. “Earlier research has shown that people with depression tend to do worse after events like heart attacks and so taking those people out of the analysis gives a more accurate measure of the association between a pessimistic or an optimistic attitude,” he says.
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There is evidence that people with optimistic outlooks have better health habits, says Rozanski. “They’re more likely to exercise, more likely to have better diets, and less likely to smoke,” he says.
A study published in January 2015 in Health Behavior and Policy Review that looked at more than 5,000 adults ages 52 to 84 found that people who were optimistic were more likely to have a healthier diet, exercise regularly, and have a body mass index (BMI) within the healthy range when compared to more pessimistic people.
Research suggests that a pessimistic outlook can have an effect on the chemistry of the brain in such factors as inflammation and metabolism, says Rozanski. “We have new data that shows people who are pessimistic are more likely to have inflammation or abnormalities in glucose metabolism or insulin resistance, which could put them at future risk for diabetes,” he says.
In a study published?in July 2017 in the Journal of Diabetes, researchers from the Women’s Health Initiative found that in a group of more than 3,000 postmenopausal women, pessimism was independently associated with higher fasting insulin and insulin resistance.
Can a Pessimist Change Their Health Destiny?
Optimism is more than just a state of mind; there are some core characteristics that this group shares, says Rozanski.
- Optimists tend to solve problems better.
- Optimists tend to soothe themselves emotionally in the face of distress better.
- Optimists are more proactive in anticipating problems.
If that doesn’t sound like you, don’t despair. “You don’t have to be born with a positive outlook to reap the benefits of optimism,” says Rozanski. “Personality studies that looked at twins who were separated early in life estimate that only about one-quarter of optimism is genetic, and the rest is from other factors,” he says.
But you can’t just make yourself be optimistic, in the same way that you can’t achieve happiness by simply trying harder to be happy, says Rozanski.
“Very often in life, if we want to achieve a certain outcome or get to a certain place, we have to do other things, where the thing we’re trying to achieve could be an outcome of that behavior,” he says. For example, getting involved in an important project or a meaningful cause could help you achieve happiness, Rozanski says.
When it comes to working toward a more optimistic attitude, what works for one person may not work for everyone, he says. It’s also something that takes practice; starting out with small changes can help you work up to bigger shifts, says Rozanski.
One way to start developing the muscle of positive thinking is to practice gratitude, says Rozanski. “That’s a credible, positive thought that’s available to anybody. Part of optimism is seeing the good in one’s ongoing life experience; gratitude is a cousin of that,” he says. One way to practice gratitude is to write down the things that you’re grateful for, says Rozanski.
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Around the 1950s, experts began to identify risk factors for cardiovascular disease, says Rozanski. “This began with the Framingham Heart Study, where we learned that high cholesterol, hypertension, smoking, and diabetes could all increase the likelihood of heart disease,” he says. Then in the 1980s, investigators found that depression, loneliness, and anxiety were also important factors, says Rozanski.
“The very first study about optimism was in 2001, and so it’s really quite recent that we’ve started to examine this,” he says. “This is the beginning of an exciting time where we can begin to look at these mindsets more carefully for their health effects and begin to work on preventative approaches for these risk factors to improve overall health,” says Rozanski.
Laffin agrees that this is where the field of cardiology is going. “We’re at a point where we do a pretty good job in treating high cholesterol and high blood pressure; now finding out how we can address these other more holistic factors is gaining importance,” he says.