Can Positivity Protect Our Hearts?

By Malika Ramani ’21
Edited by Tiffany Lin ‘21

Optimism often prevails as the supposedly superior approach to life; indeed, nearly everyone has heard the phrase “Be positive!” Studies correlating optimism with definitive health outcomes, however, considerably raise the stakes when it comes to determining how beneficial it is to adopt and maintain a positive mentality, as demonstrated by a recent study that links optimism with significantly lower cardiovascular risks.

The common risk factors for cardiovascular disease are widely recognized and include, among others, an unbalanced diet, lack of exercise, and high blood pressure. Psychological factors, however, can also significantly influence cardiovascular health, such as stress, anger, and depression (1). The optimistic route has long been considered the “healthy” one; several previous studies have shown ways in which optimism is associated not only with success in relationships, work, and school, but also with various favorable physical health outcomes (2). Many of these studies have studied optimism’s specific effects upon the heart, with one such study being a 2018 meta-analysis published in Circulation Research that revealed optimism’s link to individuals engaging in behaviors that can improve cardiovascular health (3)

This more recent meta-analysis, led by a professor of medicine at the Icahn School of Medicine at Mount Sinai, Dr. Alan Rozanski, takes the previous study’s results a step further. Published at the end of September 2019 in JAMA Network Open, it comprised of 15 studies that controlled for a wide range of cardiovascular disease risk factors, each tracking behavioral and physiological outcomes while evaluating optimism and pessimism by asking individuals to indicate their level of agreement to various statements, such as “I rarely expect good things to happen to me” and “I often feel that life is full of promises” (4). 10 of the studies specifically looked at heart disease, and the pooled data, representing more than 200,000 people, demonstrated that those with a more optimistic outlook were 35% less likely to undergo cardiovascular events (2). The studies that specifically took into account all-cause mortality – in other words, death from any cause –  similarly indicated that optimists were 14% less likely to die prematurely (2). 

Rozanski explains that optimistic people in the study were more likely to have healthier habits, including a greater tendency to exercise and eat a nutritious, well-balanced diet; they were also more likely to access therapy and engage in other stress-reducing activities (1). Additionally, the study found evidence that these individuals’ superior cardiovascular health was directly linked to even biological effects, such as lower rates of inflammation and metabolic abnormalities (2). Conversely, individuals who were more pessimistic were determined to be at higher risk for reduced blood vessel function, higher blood pressure, and shorter telomeres, which are the segments at the ends of chromosomes that shorten due to both age and stress (1). 
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Unfortunately, the takeaway from these results cannot be as simple as merely telling people to “be more positive.” It is difficult to precisely describe what constitutes “optimism” or “pessimism,” given that these terms often reflect a confluence of many psychological and physiological effects. Furthermore, optimism is also heavily influenced by genetic and environmental factors; some individuals are genetically predisposed to depression, for example, and others are affected by changes in sunlight or season (1). That being said, this study still demonstrates that paying more attention to these factors – such as by encouraging people to engage in mindfulness programs and by implementing techniques proven to reduce pessimism, like cognitive behavior therapy, into individuals’ routines – can shape and improve our approach to cardiovascular health and cardiac rehabilitation.  

Works Cited:

1. Walton AG. Being More Optimistic May Mean Better Heart Health [Internet]. Forbes. Forbes Magazine; 2019 [cited 2019 Oct 10]. Available from: https://www.forbes.com/sites/alicegwalton/2019/09/28/being-more-optimistic-may-mean-better-heart health/#7a7d01d4585f
 
2. Bakalar N. A Positive Outlook May Be Good for Your Heart [Internet]. The New York Times. The New York Times; 2019 [cited 2019 Oct 7]. Available from: https://www.nytimes.com/2019/09/27/well/mind/a-positive-outlook-may-be-good-for-your-heart.html
 
3. Boehm JK, Boehm JK, Boehm JK, Chen Y, Chen Y, Koga H, et al. Is Optimism Associated With Healthier Cardiovascular-Related Behavior? [Internet]. Circulation Research. 2018 [cited 2019 Oc t10]. Available from: https://www.ahajournals.org/doi/abs/10.1161/circresaha.117.310828
 
4. Rozanski A. Association of Optimism With Cardiovascular Events and All-Cause Mortality [Internet]. JAMA Network Open. American Medical Association; 2019 [cited 2019 Oct 10]. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752100utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=092719
 
5. Can Optimism Keep a Heart Healthy? [Internet]. American College of Cardiology. 2018 [cited 2019 Oct 10]. Available from: https://www.acc.org/latest-in-cardiology/articles/2018/09/10/16/13/can-optimism-keep-a-heart-healthy