Advertisement

Effect of Positive Well-Being on Incidence of Symptomatic Coronary Artery Disease

  • Lisa R. Yanek
    Correspondence
    Corresponding author: Tel: (410) 955-7671; fax: (410) 955-0321.
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for articles by this author
  • Brian G. Kral
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for articles by this author
  • Taryn F. Moy
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for articles by this author
  • Dhananjay Vaidya
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    Search for articles by this author
  • Mariana Lazo
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    Search for articles by this author
  • Lewis C. Becker
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for articles by this author
  • Diane M. Becker
    Affiliations
    GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    Search for articles by this author
      Although negative emotions and psychiatric morbidity have often been found to increase incident coronary artery disease (CAD) risk, fewer studies have shown positive emotions to be protective against CAD; none have been performed in high-risk healthy populations, taking risk factors into account. Thus, we examined the effect of positive well-being on incident CAD in both a high-risk initially healthy population and a national probability sample. We screened healthy siblings of probands with documented early-onset CAD from 1985 to 2007 in the GeneSTAR (Genetic Study of Atherosclerosis Risk) population and examined sociodemographic data, risk factors, and positive well-being using the General Well-Being Schedule. We further classified siblings into high-, intermediate-, and low-risk strata according to the Framingham risk score and followed them for 5 to 25 years. Siblings (n = 1,483) with greater baseline General Well-Being Schedule total scores were significantly less likely to develop CAD (hazard ratio 0.67, 95% confidence interval 0.58 to 0.79), independent of age, gender, race, and traditional risk factors. Protection was strongest in the high Framingham risk score stratum (hazard ratio 0.52, 95% confidence interval 0.30 to 0.90). The findings were replicated in the first National Health and Nutrition Examination Survey and Epidemiologic Follow-up Study (n = 5,992; hazard ratio 0.87, 95% confidence interval 0.83 to 0.93). In conclusion, positive well-being was associated with nearly a 1/3 reduction in CAD in a high-risk population with a positive family history, a nearly 50% reduction in incident CAD in the highest risk stratum in those with a positive family history, and a 13% reduction in incident CAD in a national probability sample, independent of the traditional CAD risk factors.
      To read this article in full you will need to make a payment

      References

        • Ferketich A.K.
        • Schwartzbaum J.A.
        • Frid D.J.
        • Moeschberger M.L.
        Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey.
        Arch Intern Med. 2000; 160: 1261-1268
        • Anda R.
        • Williamson D.
        • Jones D.
        • Macera C.
        • Eaker E.
        • Glassman A.
        • Marks J.
        Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults.
        Epidemiology. 1993; 4: 285-294
        • Boehm J.K.
        • Peterson C.
        • Kivimaki M.
        • Kubzansky L.
        A prospective study of positive psychological well-being and coronary heart disease.
        Health Psychol. 2011; 30: 259-267
        • Kubzansky L.D.
        • Thurston R.C.
        Emotional vitality and incident coronary heart disease: benefits of healthy psychological functioning.
        Arch Gen Psychiatry. 2007; 64: 1393-1401
        • Davidson K.W.
        • Mostofsky E.
        • Whang W.
        Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey.
        Eur Heart J. 2010; 31: 1065-1070
        • Boehm J.K.
        • Peterson C.
        • Kivimaki M.
        • Kubzansky L.D.
        Heart health when life is satisfying: evidence from the Whitehall II cohort study.
        Eur Heart J. 2011; 32: 2672-2677
        • Boehm J.K.
        • Kubzansky L.D.
        The heart's content: the association between positive psychological well-being and cardiovascular health.
        Psychol Bull. 2012; 138: 655-691
        • Huppert F.A.
        • So T.T.
        Flourishing across Europe: application of a new conceptual framework for defining well-being.
        Soc Indic Res. 2013; 110: 837-861
        • Costa Jr., P.T.
        • McCrae R.R.
        • Zonderman A.B.
        Environmental and dispositional influences on well-being: longitudinal follow-up of an American national sample.
        Br J Psychol. 1987; 78: 299-306
        • Pressman S.D.
        • Cohen S.
        Does positive affect influence health?.
        Psychol Bull. 2005; 131: 925-971
        • Vaidya D.
        • Yanek L.R.
        • Moy T.F.
        • Pearson T.A.
        • Becker L.C.
        • Becker D.M.
        Incidence of coronary artery disease in siblings of patients with premature coronary artery disease: 10 years of follow-up.
        Am J Cardiol. 2007; 100: 1410-1415
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        4th ed. American Psychiatric Association, Arlington, VA2000
        • Chen Y.
        • Zhang X.
        • Pan B.
        • Jin X.
        • Yao H.
        • Chen B.
        • Zou Y.
        • Ge J.
        • Chen H.
        A modified formula for calculating low-density lipoprotein cholesterol values.
        Lipids Health Dis. 2010; 9: 52
      1. The 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.
        Arch Intern Med. 1980; 140: 1280-1285
        • Wilson P.W.
        • D'Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • National Cholesterol Education Program
        Third report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report.
        Circulation. 2002; 106: 3143
        • Fazio A.F.
        A Concurrent Validational Study of the NCHS' General Well-Being Schedule. Report 78-1347.
        National Center for Health Statistics, Hyattsville, MD1977
      2. National Center for Health Statistics. First National Health and Nutrition Examination Survey (NHANES I). Hyattsville, MD. Available at: http://www.cdc.gov/nchs/nhanes/nhanesi.htm. Accessed May 2, 2013.

        • Wells K.B.
        • Manning Jr., W.G.
        • Valdez R.B.
        The effects of insurance generosity on the psychological distress and psychological well-being of a general population.
        Arch Gen Psychiatry. 1989; 46: 315-320
        • Taylor J.E.
        • Poston II, W.S.
        • Haddock C.K.
        • Blackburn G.L.
        • Heber D.
        • Heymsfield S.B.
        • Foreyt J.P.
        Psychometric characteristics of the general well-being schedule (GWB) with African-American women.
        Qual Life Res. 2003; 12: 31-39
      3. National Center for Health Statistics. NHANES I Epidemiologic Followup Study. Hyatsville, MD. Available at: http://www.cdc.gov/nchs/nhanes/nhefs/nhefs.htm. Accessed May 2, 2013.

        • Tindle H.A.
        • Chang Y.F.
        • Kuller L.H.
        • Manson J.E.
        • Robinson J.G.
        • Rosal M.C.
        • Siegle G.J.
        • Matthews K.A.
        Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative.
        Circulation. 2009; 120: 656-662
        • Shirai K.
        • Iso H.
        • Ohira T.
        • Ikeda A.
        • Noda H.
        • Honjo K.
        • Inoue M.
        • Tsugane S.
        Perceived level of life enjoyment and risks of cardiovascular disease incidence and mortality: the Japan public health center-based study.
        Circulation. 2009; 120: 956-963
        • Papousek I.
        • Nauschnegg K.
        • Paechter M.
        • Lackner H.K.
        • Goswami N.
        • Schulter G.
        Trait and state positive affect and cardiovascular recovery from experimental academic stress.
        Biol Psychol. 2010; 83: 108-115
        • Ikeda A.
        • Schwartz J.
        • Peters J.L.
        • Fang S.
        • Spiro III, A.
        • Sparrow D.
        • Vokonas P.
        • Kubzansky L.D.
        Optimism in relation to inflammation and endothelial dysfunction in older men: the VA Normative Aging Study.
        Psychosom Med. 2011; 73: 664-671
        • Bhattacharyya M.R.
        • Whitehead D.L.
        • Rakhit R.
        • Steptoe A.
        Depressed mood, positive affect, and heart rate variability in patients with suspected coronary artery disease.
        Psychosom Med. 2008; 70: 1020-1027
        • Giltay E.J.
        • Geleijnse J.M.
        • Zitman F.G.
        • Buijsse B.
        • Kromhout D.
        Lifestyle and dietary correlates of dispositional optimism in men: the Zutphen Elderly Study.
        J Psychosom Res. 2007; 63: 483-490
        • Kelloniemi H.
        • Ek E.
        • Laitinen J.
        Optimism, dietary habits, body mass index and smoking among young Finnish adults.
        Appetite. 2005; 45: 169-176
        • Strine T.W.
        • Chapman D.P.
        • Balluz L.S.
        • Moriarty D.G.
        • Mokdad A.H.
        The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults.
        J Community Health. 2008; 33: 40-50