Psychological well-being promotes CV health, improves CVD outcomes

Positive psychological well-being may contribute to lower risk for CVD while also supporting CV health, according to a review published in the Journal of the American College of Cardiology.

“Associations between adverse psychological factors, such as depression, and CVD are well-established,” Laura D. Kubzansky, PhD, from the department of social and behavioral sciences at Harvard T.H. Chan School of Public Health, and colleagues wrote. “However, accumulating evidence suggests that positive psychological well-being — which includes positive thoughts and feelings such as purpose in life, optimism and happiness — has its own independent associations with lower risk of CVD and may promote cardiovascular health.”

To investigate the connections between CV health and psychological well-being, researchers reviewed the related literature, determining that psychological well-being may affect CV health through biological, behavioral and psychosocial pathways and that both individual- and community-level interventions show promise in improving mental health.

Regarding biological pathways, researchers found that, despite some mixed results, psychological well-being may lead to biological alterations that mediate effects on CV health. These biological alterations include the association between psychological well-being and lower BP, with one prospective study of British adults concluding that positive mental health was associated with an 11% lower risk for developing hypertension during an 11.8-year follow-up.

The researchers also reviewed studies that examined psychological well-being in relation to American Heart Association-defined CV health behavioral factors, which include smoking, physical activity, diet and BMI, finding that most of these studies are cross-sectional and rely on self-reporting, which leaves room for potential bias. However, Kubzansky and colleagues wrote, numerous studies document a cross-sectional association between greater psychological well-being and a lower likelihood of smoking, as well as a greater likelihood of physical activity and maintaining a healthy diet.

Psychosocial mechanisms

According to the researchers, psychosocial mechanisms may mediate the association between psychological well-being and CV health because optimistic individuals tend to seek social connections and have a wide network of friends, leading to support during stressful times. In addition, optimism leads to confidence about the future, which bolsters CV health as individuals more readily act on medical advice.

As for personal-level interventions, the researchers examined several studies suggesting that mindfulness-based interventions, including deep-breathing exercises and yoga, are associated with improvements in the physical and mental health outcomes of individuals with and without existing heart disease. Examples of improved outcomes include the lessening of depressive symptoms and anxiety, lower BP and increased physical activity.

Community- and population-level interventions that take place in workplaces, churches and neighborhoods provide greater benefits to psychological well-being than individual-level interventions, according to the researchers, who found that, because most adults in the United States are employed in a workplace setting — and experience work-related stress — the AHA has several recent publications that show “resilience programs” (a mix of cognitive behavioral therapy and mindfulness) in the workplace demonstrate positive effects on work performance, psychological outcomes and physical health.

Based on these findings, the researchers recommended that health care providers promote psychological well-being at all visits, beginning with assessing the patient’s psychological distress and then emphasizing the importance of psychological well-being while making tailored recommendations based on activities and hobbies the patient enjoys.

More research needed

Kubzansky and colleagues noted that further research must be done to better define and measure psychological well-being, to investigate causal pathways that link psychological well-being and CV health and to continue focusing on appropriate interventions.

“With wider experience and further evidence, clinical practice recommendations and health policy guidelines for psychological well-being interventions could substantially affect population-level CV [health],” the researchers wrote. “Investment in the proposed research is urgently needed to realize this potential contribution of improved psychological health to better population-level CV [health] — an issue that can no longer wait.” – by Melissa J. Webb

Disclosure s : Kubzansky reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.