title: Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative.
abstract: BACKGROUND
  Trait optimism (positive future expectations) and cynical, hostile attitudes toward others have not been studied together in relation to incident coronary heart disease (CHD) and mortality in postmenopausal women.
  
  
  RESULTS
  Participants were 97 253 women (89 259 white, 7994 black) from the Women's Health Initiative who were free of cancer and cardiovascular disease at study entry. Optimism was assessed by the Life Orientation Test-Revised and cynical hostility by the cynicism subscale of the Cook Medley Questionnaire. Cox proportional hazard models produced adjusted hazard ratios (AHRs) for incident CHD (myocardial infarction, angina, percutaneous coronary angioplasty, or coronary artery bypass surgery) and total mortality (CHD, cardiovascular disease, or cancer related) over approximately 8 years. Optimists (top versus bottom quartile ["pessimists"]) had lower age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46 versus 63). The most cynical, hostile women (top versus bottom quartile) had higher rates of CHD (56 versus 44) and total mortality (63 versus 46). Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83 to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality (AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in blacks). Effects of optimism and cynical hostility were independent.
  
  
  CONCLUSIONS
  Optimism and cynical hostility are independently associated with important health outcomes in black and white women. Future research should examine whether interventions designed to change attitudes would lead to altered risk.
authors: University of Pittsburgh, PA, USA. tindleha@upmc.edu
authors: Hilary A
authors: HA
authors: Tindle
authors: Yue-Fang
authors: YF
authors: Chang
authors: Lewis H
authors: LH
authors: Kuller
authors: JoAnn E
authors: JE
authors: Manson
authors: Jennifer G
authors: JG
authors: Robinson
authors: Milagros C
authors: MC
authors: Rosal
authors: Greg J
authors: GJ
authors: Siegle
authors: Karen A
authors: KA
authors: Matthews
mesh_terms: D017677:Age Distribution; D000368:Aged; D001290:Attitude; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D015897:Comorbidity; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006791:Hostility; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D017698:Postmenopause / Q000523:psychology; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D016387:Women's Health