Abstract P224: Optimism And Favorable Cardiovascular Health Maintenance Among African Americans: The Jackson Heart Study

Abstract

Background: Higher optimism is associated with maintaining favorable cardiovascular health (FCH) among White adults, but evidence for this relationship is limited among African American adults, whose cardiovascular disease risk is higher than Whites. We investigated whether higher optimism is associated with more FCH over ~12 years among African American adults. Methods: Data were drawn from African-American women (n=2,730) and men (n=1,479) in the Jackson Heart Study (age=20-93 years). Participants free of CVD at baseline (2000–2004) were included in the analyses. Optimism was measured using the Life Orientation Test-Revised at the baseline period, and examined as a binary variable due to its skewed distribution. FCH was characterized according to whether participants had healthy status on each of five components of cardiovascular functioning (i.e., blood pressure, lipids, body mass index, type 2 diabetes, and smoking status) repeatedly assessed 3 times over ~ 12 years of follow-up; measures were obtained either from a clinical visit or via self-report. Linear mixed-effects models examined whether optimism predicted FCH level over time or FCH change rate, adjusting for covariates such as sociodemographic characteristics, depressive symptoms, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex and income as well as the likelihood of meeting the recommendation for each FCH component separately in relation to optimism using generalized estimating equations with the Poisson distribution. Results: Adjusting for all covariates, higher (vs. lower) optimism was associated with better FCH pooled across time (β=0.10, 95% confidence interval=0.02–0.17) but not with the rate of change in FCH level. We did not find sufficient evidence for effect modification by sex and income (p-interactions<0.05), which may be due to lack of power. In the analyses examining FCH sub-components, optimism was not associated with the rate of change in meeting the guidelines, except smoking; unexpectedly, participants with higher optimism had a slower rate of change towards non-smoking (p-interaction=0.03). However, this is likely driven by large differences at baseline: optimistic participants’ non-smoking proportion changed from 89.3% (baseline) to 93.2 % (visit 3) vs. 84.8% (baseline) to 92.9% (visit 3) in participants with lower optimism. In the analyses examining FCH sub-components without time-interaction, higher vs. lower optimistic participants had a higher likelihood of not being diabetic (RR=1.03, 95% confidence interval=0.99-1.07) in the fully adjusted model. Conclusions: Optimism may contribute to establishing future patterns of FCH in adulthood, but other factors may be more strongly related to how slowly or quickly favorable FCH declines over time.