title: Effect of having a sense of purpose in life on the risk of death from cardiovascular diseases.
abstract: BACKGROUND
  Many studies have focused on disease causality, but few of them deal with health-promoting factors. Thus, we examined the effect of having a sense of purpose in life (ikigai) on mortality from cardiovascular disease (CVD).
  
  
  METHODS
  In 1988, we conducted a prospective cohort study of 2,959 Japanese subjects, ranging in age from 40 to 74 years, and followed them till the end of 2003. The level of their sense of purpose in life was evaluated by a self-administered questionnaire. After excluding those with a history of heart disease, stroke, or malignant tumor, 1,618 subjects (832 men and 786 women) who had completed the questionnaire were used in the analyses with Cox's proportional hazards model.
  
  
  RESULTS
  During the average 13.3 years of follow up, 249 deaths (172 men and 77 women) occurred as a result of all causes: 32 from heart disease, 31 from stroke, 63 from CVD, and 104 from malignant tumors. The adjusted hazard ratios for death in men with a strong sense of purpose in life, as compared with those with a low sense of purpose, were 0.28 (95% confidence interval: 0.10-0.84) for stroke, 0.56 (0.28-1.10) for CVD, and 0.62 (0.45-0.86) as a result of all causes. In women, no significant relationship was found between having a sense of purpose in life and mortality; this was possibly because the smaller number of deaths reduced the statistical significance.
  
  
  CONCLUSIONS
  We found that in men, having a sense of purpose in life affected the risk of death as a result of all causes, stroke, and CVD.
authors.affiliation: Department of Public Health, Akita University School of Medicine, Akita city, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Koizumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Motohashi