title: A prospective study of positive psychological well-being and coronary heart disease.
abstract: OBJECTIVE
  Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors.
  
  
  METHODS
  Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up.
  
  
  RESULTS
  Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations.
  
  
  CONCLUSIONS
  Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA. jboehm@hsph.harvard.edu
authors.forename: Julia K
authors.initials: JK
authors.lastname: Boehm
authors.forename: Christopher
authors.initials: C
authors.lastname: Peterson
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimaki
authors.forename: Laura
authors.initials: L
authors.lastname: Kubzansky
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003327:Coronary Disease / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk; D012307:Risk Factors; D012959:Socioeconomic Factors