While depression and anxiety have long been recognised as risk factors for heart disease, there is less certainty over the beneficial effects of a 'positive' psychological state, Now, following a study of almost 8000 British civil servants, researchers say that a satisfying life is indeed good for the heart.
The results of the study are published online today by the European Heart Journal.(1)
The civil servants - who were all members of the Whitehall II study cohort in the UK with an average age of 49 years (2) - were questioned about seven specific areas of their everyday lives: love relationships, leisure activities, standard of living, job, family, sex, and one's self. They were asked to rate their satisfaction in each domain on a scale of 1 ('very dissatisfied') to 7 ('very satisfied'). Ratings for each domain were also combined to provide an average satisfaction score for their overall lives.
The participants' health records were then examined for coronary related deaths, non-fatal heart attack, and clinically verified angina over a follow-up period of around six years.
Results of the investigation showed that higher levels of average life satisfaction were associated with a reduced (and statistically significant) risk of total coronary heart disease of 13% (HR 0.87; 95% CI: 0.78 - 0.98), after controlling for demographic and other health characteristics. An approximate 13% reduced risk of heart disease was also associated with satisfaction in four of the specific life domains - job, family, sex, and self (but not with love relationships, leisure activities, or standard of living). The reduced risk of total coronary heart disease was found in both men and women.
There was a 'dose response' in these associations such that those reporting the greatest average life satisfaction appeared to enjoy the greatest risk reduction in total coronary disease. However, when examining the association between average life satisfaction and fatal or non-fatal heart attack separately from angina, reduced risk was only evident with angina, which appeared to be driving the association between life satisfaction and total coronary heart disease. Such findings may be accounted for by the relatively young age of the study participants or by the possibility that life satisfaction may relate to a general risk of atherosclerosis but not to factors predisposing individuals to heart attack. Nevertheless, the authors propose that understanding the psychological profile of patients with angina may add predictive value to an assessment of their subsequent heart disease risk.
'Taken together,' say the investigators, 'this research indicates that being satisfied with specific life domains - in particular, one's job, family, sex life, and self - is a positive health asset associated with a reduction in incident coronary heart disease independently of traditional risk factors.'
Commenting on the results, investigator Dr Julia Boehm from the Department of Society, Human Development, and Health, at the Harvard School of Public Health, Boston, USA, said: 'Although conventional risk factors such as health behaviors, blood pressure, lipids and body mass index did not explain the relationship between life satisfaction and total coronary heart disease, other behavioural or biological mechanisms that promote resilience cannot be ruled out. Moreover, these findings suggest that interventions to bolster positive psychological states - not just alleviate negative psychological states - may be relevant among high-risk individuals.'