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Optimists are less likely to have a heart attack or stroke, a major study has found

Photo by Mohamed Nohassi on Unsplash
Researchers found that optimism was linked to a 35 percent lower relative risk of experiencing a serious cardiovascular-related event, such as heart attack, stroke or cardiac arrest, and a 14 percent lower relative risk of early death.

People with a positive outlook on life are less likely to have a heart attack, stroke or other cardiovascular “event” than those who are pessimistic, according to a major new review and analysis of existing studies.

They are also less likely to die prematurely of any cause, the study found.

“We saw that there was about a 35 percent reduced risk of having a heart attack, stroke, [or] cardiac death in people who rated themselves positively as opposed to negatively,” said cardiologist Dr. Alan Rozanski, the study’s lead author and a professor of medicine at the Icahn School of Medicine at Mount Sinai, in an audio interview released with the study.

“That’s a very substantial effect, a medical effect, similar to what we see with other risk factors, even things such as hypertension,” he added.


The study, which was published last week in JAMA Network Open, also made the “fascinating” finding, said Rozanski, of a dose-response relationship between optimism and heart health. In other words, the more optimistic people are, the lower their chances of experiencing a serious cardiovascular complication.

As an editorial that accompanies the study points out, a large and growing body of research has identified psychological well-being in general — and optimism in particular — as being associated with better health outcomes, independent of other risk factors, such as physical activity, socioeconomic status or depression.

Indeed, just last August, researchers reported that people who are optimistic are significantly more likely to live past the age of 85 than those who are pessimistic, even after accounting for factors that affect lifespan, such as chronic illnesses, depression, educational attainment, alcohol use, diet and how often people see their doctors for preventive check-ups.

Examining multiple studies

In the current study, Rozanski and his colleagues focused on what the existing scientific literature says about the link between optimism and heart health. They conducted a systematic review and meta-analysis of 15 studies involving 200,000-plus participants who were followed for an average of almost 14 years. The studies were all published within the past 20 years. Eight were done in the United States, while the rest were carried out in Europe, Australia and Israel.

Ten of the studies looked specifically at optimism’s association with cardiovascular events, while the others looked at the association with death from any cause. Questionnaires were used in the studies to assess participants’ levels of optimism and pessimism.

When all that data was pooled and analyzed, the researchers found that optimism was linked to a 35 percent lower relative risk of experiencing a serious cardiovascular-related event, such as heart attack, stroke or cardiac arrest, and a 14 percent lower relative risk of early death.

Those findings held across all age groups and even after the researchers included in their analysis only the studies that controlled for other factors that affect heart health, such as physical activity, depression and educational level.

Two key factors

The study comes with several caveats. Most notably, the studies used different tools to measure optimism and different cut-off points to distinguish between optimism and pessimism.


Still, the meta-analysis’ results were very robust, says Rozanski, and were reproducible across all the studies.

Why would optimism play such a significant role in heart health? Rozanski points to two possible explanations. One is biochemical.

“Optimists tend to have better metabolic function,” he explains. “[They’re] less likely to have insulin resistance, less likely to have inflammation” — perhaps, he suggests, because they have lower levels of stress hormones circulating in their bodies.

The other possible explanation for optimism’s link to heart health is behavioral.

“Optimists engage in better health behaviors,” says Rozanski. “They’re more likely to exercise. They’re less likely to smoke. They have better diets. They watch their weight better. And that is, by the way, one of the key mechanisms, perhaps the most important mechanism, but certainly one of the key mechanisms, … why optimists actually have better health, live longer, have less heart disease.”

Turning pessimists into optimists

Rozanski is, well, optimistic about helping people become more optimistic. As he explains in the audio interview, optimists are people who believe they can handle any obstacles thrown in front of them.

“They not only think they’re going to have a better future, they’re better at anticipating their problems which may come their way and taking proactive steps beforehand to do it, or what we call proactive coping,” Rozanski says.

That way of thinking can be learned, he stresses. Yes, there is a genetic component to optimism, but research involving twins raised separately suggests that genetics likely explains only about 25 percent of the trait.


The first step in becoming more optimistic, says Rozanski, involves recognizing the quality of your thoughts — just as you might think about the quality of your diet or exercise habits.

“If you feel you don’t feel as positive as you should, then I’d say the next thing is just start with this thought recognition,” he says. “Start to recognize what the pessimistic thinking is, and once you do that and you want to do that, it puts you on the road to eventually dismissing these thoughts and reframing.”

Reframing doesn’t mean just thinking positive thoughts. It means learning that there are other ways of looking at the future.

“Where we like to start is in the area of gratitude,” says Rozanski. “Gratitude is something that isn’t inherently logical to people. When we hear it, we say, ‘Oh yeah.’ But we just pay lip service to it. It’s actually something hard to do because you have to overcome the lip service, but you can do it.”

“When you start to feel more grateful, it starts to engender positive feelings,” he adds. “And then you start to get on the road and say, ‘Hey, I have a little bit more perspective. I’ve crowded out the negative feelings.’”

FMI: You can read the study in full on the JAMA Network Open website.

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