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Optimism associated with better CHD mortality outcomes than cynicism, hostility in women
Women who were more optimistic and had more positive future expectations had better coronary heart disease outcomes than those who were cynically hostile.
Researchers evaluated 97,253 women from the Women’s Health Initiative (89,259 white, 7,994 black) who were free of cancer and CVD at study entry. The researchers assessed optimism by the Life Orientation Test-Revised and cynical hostility by the cynicism subscale of the Cook Medley Questionnaire.
According to the study results, age-adjusted incident CHD rates increased in a stepwise fashion with decreasing optimism levels, from 43 events per 10,000 women among optimists to 60 events per 10,000 women among pessimists (P<.0001 for trend). For cynical hostility, age-adjusted incident CHD rates decreased in a stepwise fashion with decreasing hostility from 56 events per 10,000 women in the most cynically hostile women to 44 events per 10,000 women least cynically hostile (P<.0001). All-cause mortality rates per 10,000 women increased as optimism decreased (P<.00001 for trend), particularly among black women. In black women, the all-cause mortality rates among optimists vs. pessimists was 47 deaths vs. 85 deaths (P<.0001), and were also higher among the most cynically hostile vs. the least cynically hostile (87 deaths vs. 39 deaths, P<.0001). The most cynically hostile women also had a higher hazard of cancer-related mortality (adjusted HR=1.23; 95% CI, 1.09-1.40) and total mortality (adjusted HR=1.16; 95% CI, 1.07-1.27). A Cox proportional hazard analysis suggested that optimistic women had significantly reduced adjusted hazard ratios for all outcomes excluding cancer-related mortality when compared with cynically hostile women.
“It psychological attitudes such as optimism and cynical hostility matter for health, the extent to which they can be modified remains unclear,” the researcher wrote in the study. “Further research is needed to understand how and why optimism and cynical hostility affect health outcomes in women and how they develop in earlier stages of life, as well as to identify these attitudes in healthy ways.”
Tindle H. Circulation. 2009;doi:10.1161/CIRCULATIONAHA.108.827642.
This was a very large, solid study that detected small but important differences in mortality and CVD associated with optimism and pessimism in women in the predicted hypothesized direction – optimism is good for health. There are some remaining questions. The first is a horse or cart question, eg, are folks optimistic because they are younger, better educated and have fewer health issues? Regarding confounding variables, do optimists have better health because they are more adherent to health habits (such as healthful lifestyle practices and medication)? Finally…Is it possible to change personality traits to less cynical/more optimistic? Is this an avenue that can be employed to improve health?
Cardiology Today Editorial Board member