title: Is the association between optimistic cardiovascular risk perceptions and lower rates of cardiovascular disease mortality explained by biomarkers of systemic inflammation or endothelial function? A case-cohort study.
abstract: BACKGROUND
  More optimistic perceptions of cardiovascular disease risk are associated with substantively lower rates of cardiovascular death among men. It remains unknown whether this association represents causality (i.e. perception leads to actions/conditions that influence cardiovascular disease occurrence) or residual confounding by unmeasured factors that associate with risk perceptions and with physiological processes that promote cardiovascular disease (i.e. inflammation or endothelial dysfunction).
  
  
  OBJECTIVE
  To evaluate whether previously unmeasured biological markers of inflammation or endothelial dysregulation confound the observed association between cardiovascular disease risk perceptions and cardiovascular disease outcomes;
  
  
  METHODS
  We conducted a nested case-cohort study among community-dwelling men from Southeastern New England (USA) who were interviewed between 1989 and 1990 as part of the Pawtucket Heart Health Program. We measured C-reactive protein (CRP) and Vascular Endothelial Growth Factor (VEGF) levels from stored sera for a random sample of the parent cohort (control sample, n = 127) and all cases of cardiovascular death observed through 2005 (case sample, n = 44). We evaluated potential confounding using stratified analyses and logistic regression modeling.
  
  
  RESULTS
  Optimistic ratings of risk associated with lower odds of dying from cardiovascular causes among men (OR = 0.39, 95% CI = 0.17, 0.91). Neither CRP nor VEGF confounded these findings.
  
  
  CONCLUSIONS
  The strong cardio-protective association between optimistic ratings of cardiovascular disease risk and lower rates of cardiovascular mortality among men is not confounded by baseline biomarkers of systemic inflammation or endothelial dysfunction.
authors.affiliation: Department of Family Medicine, University of Rochester, 1381 South Avenue, Rochester, NY 14620, USA. Robert_Gramling@URMC.Rochester.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
authors.forename: Kathi L
authors.initials: KL
authors.lastname: Heffner
authors.forename: William Mp
authors.initials: WM
authors.lastname: Klein
authors.forename: Laura E
authors.initials: LE
authors.lastname: Zajac
authors.forename: Mary
authors.initials: M
authors.lastname: Roberts
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton