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The concept of cardiovascular health (CVH) was developed by the American Heart Association, and is based on a shift of focus away from disease treatment and toward health prevention and promotion.¹ CVH is a fundamental part of well-being even before the development of risk factors, and according to current research, less than 10% of middle-aged adults meet the criteria for favorable CVH.² In fact, cardiovascular diseases make up the largest portion of the modern non-communicable chronic disease epidemic (which include metabolic syndrome, obesity, degenerative brain disorders, cancer and autoimmune diseases), and they are the leading cause of death on a global scale.³ Amongst other lifestyle factors, the Western diet has been identified as a major risk factor for all these diseases.

There are several well-known factors that have been shown to positively affect CVH: a largely plant based diet (like the Mediterranean or Okinawan),⁴ low in saturated fat and in highly processed carbohydrates and high in fiber and polyphenols, regular physical exercise, the elimination of smoking, and a healthy body mass index.¹ However, often neglected, research has also explored the role of the mind and mental states as an important determinant of CVH. According to a recent paper published by Julia Boehm and colleagues in the journal Psychosomatic Medicine, an optimistic view of life may have a small, but significantly favorable effect on CVH. The study, performed over a 10-year time period in 5,115 male and female participants from all socio demographic backgrounds found a small but statistically significant correlation between optimism and CVH, a correlation that was strongest in women.² Even though the observed correlation was small, the authors emphasize the impact such a relatively small correlation can have on health outcomes across the life-span of a large population.² In an earlier study, using a meta-analysis of 15 published studies, optimistic individuals were found to have a 35% decreased risk of suffering a cardiovascular event, when compared to individuals who were less optimistic.⁵

There are several reasons which could explain these findings: 1) Optimistic individuals often are more likely to pursue healthy lifestyles, including physical activity, healthy diets and social interactions, and are more likely to use effective coping strategies in the event of distress.⁶ More precisely, optimism was shown to reduce maladaptive coping mechanisms such as avoidance and withdrawal from stressful emotions. On the other hand, optimism was shown to increase positive coping strategies such as management and reduction of stressors,⁷ and positive persistence during challenging times, while disengaging from ineffective activities.⁸

From a biological perspective, an optimistic view on life may result from the activity of brain networks involved in making predictions about future events. A negative bias of such networks, regularly assuming a high likelihood of negative outcomes has been identified in patients with chronic pain,⁹ depression and anxiety, conditions often associated with poor CVH. The causality between optimism and CVH remains to be determined. Optimism may positively affect CVH, but scientists also debate whether there could be a reverse correlation, such that improved CVH leads to increased levels of optimism.

The health-focused view underlying the CVH concept, emphasizes the importance of minimizing the development of risk factors for cardiovascular disease in the first place, and instead focusing on preserving sustainable cardiovascular health.¹⁰ Factors such as normal blood pressure, normal body mass index, absence of type II diabetes, and being a non-smoker¹¹ are used as cardiovascular health indicators and can easily be used for self-analysis from home.

So for anyone aiming to improve their CVH, learning to look at a glass half full and striving towards a more optimistic mindset, while also making sure to maintain a normal weight, keeping up with regular exercise and adhering to a heart-healthy diet are valuable investments in future health.

References

1. Circulation Volume 121, Issue 4, 2 February 2010, Pages 586-613 https://doi.org/10.1161/CIRCULATIONAHA.109.192703AHA SPECIAL REPORT Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction
2. Boehm, Julia K. PhD, et. al. Optimism and Cardiovascular Health: Longitudinal Findings From the Coronary Artery Risk Development in Young Adults Study, Psychosomatic Medicine: October 2020 – Volume 82 – Issue 8 – p 774-781 doi: 10.1097/PSY.0000000000000855.
3. Mozaffarian D, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 2015;131:e29–322.
4. Martinez-Gonzales MA et al. The Mediterranean Diet and Cardiovascular Health: A Critical Review. Circulation research 124:779-798, 2019.
5. Rozanski A, et al. Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta- analysis. JAMA Netw Open 2019;2:e1912200.
6. Boehm JK, et al. Is optimism associated with healthier cardiovascular-related behavior? Meta-analyses of 3 health behaviors. Circ Res 2018;122:1119–34.
7. Nes LS, Segerstrom SC. Dispositional optimism and coping: a meta-analytic re- view. Pers Soc Psychol Rev 2006;10:235–51.
8. Brissette I, et al. The role of optimism in social network development, coping, and psychological adjustment during a life transition. J Pers Soc Psychol 2002;82:102–11.
9. Mayer EA, et al. Towards a systems view of IBS. NRGH 2015.
10. Lloyd-Jones DM, et al. and American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Associ- ation’s strategic impact goal through 2020 and beyond. Circulation 2010;121: 586–613.
11. Daviglus ML, et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA 2004;292:1588–92.

By Jill Horn with Emeran A. Mayer, MD