Optimists Can Look Forward to Longer Life

Optimism was associated with reduced risk of death due to all causes as well as fewer cardiovascular events, a meta-analysis and systematic review found.

Positive mindset was significantly linked with decreased cardiovascular event risk (RR 0.65; P<0.001), with high heterogeneity in the pooled analysis (I²=87.4%), reported Alan Rozanski, MD, of Mount Sinai St Luke's Hospital in New York City, and colleagues in JAMA Network Open.

Death from any cause was a relative 14% less common for positive people during the average 13.8 years of follow-up (P<0.001), with moderate heterogeneity (I²=73.2%).

The more positive one responded to questions about how likely good things were to happen in the future, the better the outcomes across all 12 studies with a gradient of responses were possible.

Results were similar between the sexes and across follow-up durations. Adjustment for depression and other possible confounders did little to change the results, the researchers added.

"The findings suggest that a mindset of optimism is associated with lower cardiovascular risk and that promotion of optimism and reduction in pessimism may be important for preventive health," the authors wrote.

These findings are consistent with a growing and large literature showing that optimism in particular, and psychological well-being in general, have an independent association with cardiovascular and overall health outcomes, wrote Jeff Huffman, MD, of Massachusetts General Hospital in Boston, in an accompanying editorial.

Further longitudinal studies that assess the relationships of more state-based or modifiable constructs with health outcomes would help to define plausible, clear, and important targets for intervention, noted Huffman.

Intervention studies should emphasize measuring and improving not only well-being, but also important additional downstream outcomes, like biomarkers and physical activity, Huffman highlighted.

"Ongoing studies should also determine whether programs to promote psychological well-being might be best used alone or in conjunction with other, established behavioral interventions to boost their effect," the editorialist concluded.

Rozanski's group evaluated 229,391 participants across 15 studies. There were nine studies reporting all-cause mortality data and 10 studies reporting data on cardiovascular events. Studies of cancer patients were excluded.

Limitations included that the meta-analysis involved studies with cohorts of widely varying ages, widely varying covariates, and considerable heterogeneity in scales and the cutpoints used for them, the researchers acknowledged.

"Future studies should seek to better define the biobehavioral mechanisms underlying this association and evaluate the potential benefit of interventions designed to promote optimism or reduce pessimism," the authors concluded.