Physicians' Academy for Cardiovascular Education

Optimism associated with reduced risk of CV events and all-cause mortality

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

Literature - Rozanski A, Bavishi C, Kubzansky LD et al. - JAMA Network Open. 2019;2(9):e1912200, doi:10.1001/jamanetworkopen.2019.12200

Introduction and methods

An association between negative emotions, social factors and certain chronic stress with adverse CV outcomes have been well demonstrated [1]. However, evidence for an association between positive and negative mindsets with CV risk is more limited. Mind-sets can perhaps be modified and therefore a potential target for clinical intervention.

A systematic review and meta-analysis was conducted to examine the association between optimism and adverse CV outcomes. For this purpose, Pubmed, Scopus and PsycINFO databases were search for articles published from inception until July 2019. Studies were included if they reported association of optimism with all-cause mortality and/or CV events and listed adjusted risk estimated with 95%CIs. Studies with cancer patients were excluded. CV outcome was a composite of fatal CV mortality, non-fatal myocardial infarction, stroke, and/or new-onset angina.

Most studies compared multiple categories of optimism and reported effect estimates for highest levels of optimism vs lowest reference categories.

Main results


In a meta-analysis comprising of more than 220,000 individuals, optimism was associated with a reduced risk of CV events and all-cause mortality. Interventions promoting optimism or reducing pessimism may be important targets to improve outcomes.

Editorial comment

In an editorial comment [3] Jeff C Huffman wrote that the findings of this meta-analysis add up to the growing body of evidence that positive psychological well-being and more particular, optimism, are independently associated with CV and overall health outcomes. He then asked two questions: (1) which specific positive psychological constructs are associated with medical health, and (2) which constructs are modifiable in a clinical or population-level intervention?

Regarding the first question, the specific construct that was most consistently associated with health outcomes was dispositional optimism (measured by the Life Orientation Test-Revised), which a largely stable trait. In terms of intervention, if it a person’s inherent optimistic mindset that results in better outcomes, this may be difficult to modify.

With regard to the second question, most data on this topic exist for state-based concepts, such as positive affect or happiness. Positive psychology interventions have demonstrated to increase positive affect, which has been associated with reduced mortality and improved outcomes in medical populations.

Finally, Huffman listed several ideas for future studies: examine associations of more modifiable or state-based constructs with outcomes that will hopefully help to determine targets for intervention, use novel methods to measure well-being, do not only focus on well-being for interventions, but also on important downstream outcomes, such as physical activity and biomarkers, and examine whether programs to increase psychological well-being are best used alone or together wit others.


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