It is well known that mental and emotional factors can influence heart disease risk and recovery from heart problems. For example, depression can increase your risk of heart disease by 50%, and women who have had a heart attack or heart procedure are more likely to suffer from depression. Anxiety, hostility, and mental and emotional stress also affect the long-term health of your heart and blood vessels.
This latest study included nearly 100,000 postmenopausal women (50 to 79 years of age) from the Women's Health Initiative study who were free of heart disease and cancer when the study began. They took psychological tests to determine their levels of optimism and "cynical hostility" and were followed for 8 years to find the link between these mental characteristics and health outcomes. Although previous studies have found links between hostility and heart disease risk, this was the first study to examine the relationship between and optimistic outlook and the risk of developing heart disease in women.
Sample questions on the optimism test included "In unclear times, I will usually expect the best" (rating this item higher is more optimistic) and "If something can go wrong for me, it will" (rating this item lower is more optimistic). The cynical hostility test (a measure of the tendency to harbor hostile thoughts about others or generally mistrust other people) included questions such as "I have often taken orders from someone who did not know as much as I did" and "It is safer to trust nobody" (rating these items higher is more cynical or hostile).
Compared with pessimists, optimists were 9% less likely to develop heart disease (including chest pain or heart attack) or need a procedure to treat heart disease (angioplasty or bypass surgery). Optimists were also 30% less likely to die of heart disease.
After other health factors were taken into account, women who exhibited hostile and cynical attitudes were no more likely to develop heart disease than less hostile women. However, they were 16% more likely to die during the study, and 23% more likely to die of cancer compared with women who scored low on the hostility test. These associations were most pronounced in black women, in whom cynical hostility increased the risk of dying by 62% and the chances of dying from cancer by 142%.
It is not known exactly how mental outlook changes a woman's heart risk. It may affect the heart and blood vessels directly, for example by slowing down the progress of atherosclerosis, the buildup of fatty deposits on the walls of the arteries. A positive mental outlook could also work in an indirect way by making a woman more likely to have healthy behaviors. In this study, optimistic women were less likely to have diabetes, high blood pressure, high cholesterol, smoke, not get enough exercise, and be overweight or depressed – all important risk factors for heart disease. Optimists may also cope with adversity, such as heart problems, in healthier ways.
Further research is needed to understand how and why optimism and cynical hostility affect health outcomes in women, including how they develop in earlier stages of life. This could also lead to the development of therapies to alter these attitudes in healthy ways. Whatever your outlook, all women can benefit from taking steps to identify and control their heart disease risk factors and making healthy lifestyle changes to lower their chances of developing heart disease.
Source: Tindle HA, Chang Y-F, Kuller LH, et al. Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women's Health Initiative. Circulation. 2009;120:656-662