Positive psychological aspects of well-being—including positive emotions, optimism, and life satisfaction—are increasingly considered to have protective roles for cardiovascular disease (CVD) and longevity. A rapidly-growing body of literature has linked positive well-being with better cardiovascular health, lower incidence of CVD in healthy populations, and reduced risk of adverse outcomes in patients with existing CVD. This review first examines evidence on the associations of positive well-being with CVD and mortality, focusing on recent epidemiological research as well as inconsistent findings.
Positive well-being is defined as the presence of favourable emotional or cognitive psychological attributes, such as positive affect (i.e., positive emotions) and optimism. Well-being is not simply the absence of mental illness nor is it the opposite of negative psychological constructs such as depression. Although positive and negative psychological factors are inversely correlated, positive well-being often remains independently predictive of subsequent health outcomes after accounting for depression or negative affect.
It has been increasingly recognized that psychosocial and behavioural factors earlier in life can contribute to the development of CVD over the course of years to decades. Given the paramount importance of primary prevention, the American Heart Association (AHA) has called for an improvement in “cardiovascular health” as part of the AHA 2020 Impact Goals. The concept of cardiovascular health is defined by not only the absence of clinically manifest CVD but also the simultaneous presence of 4 optimal lifestyle behaviours (non-smoking, physical activity, healthy diet, and normal body weight) and 3 favourable biomarker levels (optimal total cholesterol, blood pressure, and fasting blood glucose without drug treatment). A cross-sectional analysis of the Multi-Ethnic Study of Atherosclerosis demonstrated a graded association between optimism and cardiovascular health scores, whereby participants in the highest quartile of optimism had 92% greater odds of ideal cardiovascular health compared to the least optimistic participants.
Positive well-being is thought to influence CVD by (a) promoting adaptive physiological functioning, (b) motivating better health behaviours, and (c) buffering against the detrimental effects of stress on health. These 3 pathways are interrelated and not mutually exclusive. Moreover, the reversed causal direction (i.e., good health leading to positive well-being) is possible, as are reciprocal effects between positive well-being and health.
In addition to psychological dispositions, positive activities and experiences in daily life are important for health. Recent studies indicate that people who experience more daily positive events (e.g., having a pleasant conversation, spending time in nature) and who are involved in productive activities, particularly volunteering, tend to have lower levels of inflammation.
Positive well-being may also have protective influences on cardiovascular function and cardiac autonomic control. In a study where older adults’ emotions and blood pressure were assessed every day for 60 days, daily positive emotions counteracted the influence of negative emotions on systolic blood pressure. The study also found that participants with higher levels of social connectedness tended to have elevated positive emotions and more rapid systolic blood pressure recovery from negative emotions, suggesting that socially connected people may be more adept than less-connected individuals at mobilizing positive emotions to regulate negative experiences.