Abstract
Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship.Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk.Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04–1.16] and 1.05 (95% CI: 0.99–1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98–1.12) and 1.04 (0.97–1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0–1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98–1.03) and 1.01 (0.98–1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics.Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.
Highlights
Cardiovascular disease (CVD) is the leading cause of death in men and women, and in most racial/ethnic groups in the United States (U.S.) [1]
cardiovascular health (CVH) is determined by Life’s Simple 7 (LS7) metrics that consist of three behavioral and four biological factors (body mass index (BMI), blood pressure (BP), total cholesterol, and fasting glucose) [11]
Given the previously mentioned gaps in the literature, the objective of this study is to examine the relationship between optimism and ideal CVH prospectively, where composite LS7 metrics will measure CVH outcomes
Summary
Cardiovascular disease (CVD) is the leading cause of death in men and women, and in most racial/ethnic groups in the United States (U.S.) [1]. The mortality rate among Black non-Hispanic adults was higher than White non-Hispanic adults and was almost 2-fold higher than Hispanic adults [3] These racial/ethnic health disparities are shaped by structural racism that negatively impacts the social determinants of health [4], resulting in greater exposures to psychosocial risks and engagement in adverse health behaviors related to CVD [5,6,7,8,9,10]. CVH is determined by LS7 metrics that consist of three behavioral (smoking, physical activity, diet) and four biological factors (body mass index (BMI), blood pressure (BP), total cholesterol, and fasting glucose) [11] This measure, which can be categorized into ideal, intermediate, or poor CVH for each indicator or the sum total of LS7 metrics, has been examined in various studies and shown to be a strong independent marker for CVD outcomes [12,13,14]. This study examines the prospective relationship between optimism and CVH outcomes based on the Life’s Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship
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