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      Association of Optimism With Cardiovascular Events and All-Cause Mortality : A Systematic Review and Meta-analysis

      , MD , 1 , 2 , 3 , , MD, MPH 4 , , PhD 5 , , MD 6

      JAMA Network Open

      American Medical Association

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          Abstract

          This meta-analysis assesses whether individuals with a mindset of optimism have a lower risk of cardiovascular events and all-cause mortality.

          Key Points

          Question

          Is a mindset of optimism associated with a lower risk of cardiovascular events and all-cause mortality?

          Findings

          In this meta-analysis of 15 studies including 229 391 individuals, optimism was associated with a lower risk of cardiovascular events and pessimism was associated with a higher risk of cardiovascular events; the pooled association was similar to that of other well-established cardiac risk factors.

          Meaning

          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.

          Abstract

          Importance

          Optimism and pessimism can be easily measured and are potentially modifiable mindsets that may be associated with cardiovascular risk and all-cause mortality.

          Objective

          To conduct a meta-analysis and systematic review of the association between optimism and risk for future cardiovascular events and all-cause mortality.

          Data Sources and Study Selection

          PubMed, Scopus, and PsycINFO electronic databases were systematically searched from inception through July 2, 2019, to identify all cohort studies investigating the association between optimism and pessimism and cardiovascular events and/or all-cause mortality by using the following Medical Subject Heading terms: optimism, optimistic explanatory style, pessimism, outcomes, endpoint, mortality, death, cardiovascular events, stroke, coronary artery disease, coronary heart disease, ischemic heart disease, and cardiovascular disease.

          Data Extraction and Synthesis

          Data were screened and extracted independently by 2 investigators (A.R. and C.B.). Adjusted effect estimates were used, and pooled analysis was performed using the Hartung-Knapp-Sidik-Jonkman random-effects model. Sensitivity and subgroup analyses were performed to assess the robustness of the findings. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed.

          Main Outcomes and Measures

          Cardiovascular events included a composite of fatal cardiovascular mortality, nonfatal myocardial infarction, stroke, and/or new-onset angina. All-cause mortality was assessed as a separate outcome.

          Results

          The search yielded 15 studies comprising 229 391 participants of which 10 studies reported data on cardiovascular events and 9 studies reported data on all-cause mortality. The mean follow-up period was 13.8 years (range, 2-40 years). On pooled analysis, optimism was significantly associated with a decreased risk of cardiovascular events (relative risk, 0.65; 95% CI, 0.51-0.78; P < .001), with high heterogeneity in the analysis ( I 2 = 87.4%). Similarly, optimism was significantly associated with a lower risk of all-cause mortality (relative risk, 0.86; 95% CI, 0.80-0.92; P < .001), with moderate heterogeneity ( I 2 = 73.2%). Subgroup analyses by methods for assessment, follow-up duration, sex, and adjustment for depression and other potential confounders yielded similar results.

          Conclusions and Relevance

          The findings suggest that optimism is associated with a lower risk of cardiovascular events and all-cause mortality. 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.

          Related collections

          Most cited references 41

          • Record: found
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          Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.

          Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
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            The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology.

            Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.
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              • Abstract: found
              • Article: not found

              Dispositional optimism and physical well-being: the influence of generalized outcome expectancies on health.

              This article explores the implications that dispositional optimism holds for physical well-being. Research is reviewed that links optimism to a number of different positive health-relevant outcomes, ranging from the development of physical symptoms to recovery from coronary artery bypass surgery. Additional findings are described which suggest that these beneficial effects are partly due to differences between optimists and pessimists in the strategies that they use to cope with stress. A number of other potential mediators are also discussed, including some that are physiologic in nature. The article closes with a discussion of the relationships between our own theoretical account of the effects of optimism and several other conceptual approaches.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                27 September 2019
                September 2019
                27 September 2019
                : 2
                : 9
                Affiliations
                [1 ]Department of Cardiology, Mount Sinai St. Luke’s Hospital, New York, New York
                [2 ]Department of Cardiology, Mount Sinai Heart, New York, New York
                [3 ]Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
                [4 ]Department of Cardiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence
                [5 ]Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
                [6 ]Department of Cardiology, Crystal Run Healthcare, West Nyack, New York
                Author notes
                Article Information
                Accepted for Publication:
                Published:10.1001/jamanetworkopen.2019.12200
                Open Access: CC-BY License JAMA Network Open
                Corresponding Author: Alan Rozanski, MD, Department of Cardiology, Mount Sinai St Luke’s Hospital, 1111 Amsterdam Ave, New York, NY 10025 ( alan.rozanski@ 123456mountsinai.org ).
                Author Contributions:
                Concept and design:
                Acquisition, analysis, or interpretation of data:
                Drafting of the manuscript:
                Critical revision of the manuscript for important intellectual content:
                Statistical analysis:
                Administrative, technical, or material support:
                Supervision:
                Conflict of Interest Disclosures:
                Article
                zoi190464
                10.1001/jamanetworkopen.2019.12200
                6777240
                31560385
                Copyright 2019 Rozanski A et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                Categories
                Research
                Original Investigation
                Online Only
                Cardiology

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