Over the last few decades numerous studies have shown negative states, such as depression, anger, anxiety, and hostility, to be detrimental to cardiovascular health. Less is known about how positive psychological characteristics are related to heart health. In the first and largest systematic review on this topic to date, Harvard School of Public Health (HSPH) researchers found that positive psychological well-being appears to reduce the risk of heart attacks, strokes and other cardiovascular events.

The study was published online April 17, 2012 in Psychological Bulletin.
"The absence of the negative is not the same thing as the presence of the positive. We found that factors such as optimism, life satisfaction, and happiness are associated with reduced risk of CVD regardless of such factors as a person's age, socioeconomic status, smoking status, or body weight," said lead author Julia Boehm, research fellow in the Department of Society, Human Development, and Health at HSPH. "For example, the most optimistic individuals had an approximately 50% reduced risk of experiencing an initial cardiovascular event compared to their less optimistic peers," she said.

In a review of more than 200 studies published in two major scientific databases, Boehm and senior author  Laura Kubzansky, associate professor of society, human development, and health at HSPH, found there are psychological assets, like optimism and positive emotion, that afford protection against cardiovascular disease. It also appears that these factors slow the progression of disease.

In particular, three recent Japanese studies found that people who had a sense of mastery or control over their lives had a lower risk of dying from myocardial infarction or stroke.  An American study involving 2,500 adults linked emotional well-being to a 26 percent reduced risk of stroke over a 6-year period compared to those who had lower levels of well being.  Eight other studies found an association between optimism and a lower risk of heart disease.

To further understand how psychological well-being and CVD might be related, Boehm and Kubzansky also investigated well-being's association with cardiovascular-related health behaviors and biological markers. They found that individuals with a sense of well-being engaged in healthier behaviors such as exercising, eating a balanced diet, and getting sufficient sleep. In addition, greater well-being was related to better biological function, such as lower blood pressure, healthier lipid profiles, and normal body weight.

If future research continues to indicate that higher levels of satisfaction, optimism, and happiness come before cardiovascular health, this has strong implications for the design of prevention and intervention strategies. "These findings suggest that an emphasis on bolstering psychological strengths rather than simply mitigating psychological deficits may improve cardiovascular health," Kuzbansky said.

The study was supported by the Robert Wood Johnson Foundation's Pioneer Portfolio through the grant "Exploring Concepts of Positive Health."