Elsevier

Progress in Cardiovascular Diseases

Volume 76, January–February 2023, Pages 91-98
Progress in Cardiovascular Diseases

Association of pessimism with cardiovascular events and all-cause mortality

https://doi.org/10.1016/j.pcad.2022.11.018Get rights and content

Abstract

Poor psychological health is associated with Takotsubo cardiomyopathy, cardiac syndrome X, coronary microcirculatory dysfunction, peripheral artery disease, or spontaneous coronary artery dissection. Data regarding pessimism, cardiovascular disease (CVD) events and mortality and all-cause mortality remained inconclusive. This systematic review and meta-analysis aim to provide an overview of the association between pessimism, CVD outcomes and mortality. A systematic search of electronic databases was conducted from inception through July 2022 for studies evaluating pessimism and adverse outcomes. A total of 17 studies published between 1966 and July 2022 met our inclusion criteria, for a total of 232,533 individuals. Pooled hazard ratios were calculated in random-effects meta-analyses. Based on pooled analysis of adjusted HRs, pessimism was associated with adjusted HR of 1.13 (95% CI 1.07–1.19) for all-cause mortality with minimal heterogeneity (I2 = 28.5%). Based on pooled analysis of adjusted HRs, pessimism was associated with adjusted HR of 1.30 (95% CI 0.43–3.95) for CHD mortality, adjusted HR of 1.41 (95% CI 1.05–1.91) for CVD mortality, and adjusted HR of 1.43 (95% CI 0.64–3.16) for stroke. In conclusion, pessimism seems to be significantly associated with a higher risk for and poorer outcomes from CVD events than optimistic styles. There are genetic and other bases for these life approaches, but behavioral, cognitive and meditative interventions can modify patients' level of pessimism, hopefully leading to better medical outcomes. Testing this theory would yield highly useful and practical data for clinical care.

Introduction

Psychosocial health has been associated with cardiovascular (CV) health.1,2 Indeed, poor psychological health is associated with Takotsubo cardiomyopathy,3 cardiac syndrome X,4 coronary microcirculatory dysfunction,5 peripheral artery disease,6 or spontaneous coronary artery dissection.7 A previous meta-analysis showed that individuals with optimism have longer survival than individuals with pessimism.8 However, data regarding pessimism, CV disease (CVD) events and mortality remained inconclusive, even though a recent study showed that age-adjusted pessimism scores may be associated with all-cause and CVD mortality.9 Therefore, we performed a systematic review and meta-analysis of studies that have assessed the association between pessimism, CVD outcomes and mortality.

Section snippets

Data sources and searches

An experienced librarian (S.F.) developed search strategies for the literature review. We conducted a comprehensive search and extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through July 2022 for all original studies that evaluated individuals with the following Medical Subject Heading terms: pessimism, outcomes, endpoint, mortality, death, cardiovascular events, stroke, coronary artery

Results

A flow diagram of the literature searches and related screening process is shown in Fig. 1. A total of 17 studies published between 1966 and July 2022 met our inclusion criteria, for a total of 232,533 individuals. Of the 17 studies, 10 studies reported data pertaining to all-cause mortality (n = 191,577). Incidence of coronary heart disease (CHD) related mortality was assessed in 98,129 participants derived from data of 2 studies, incidence of CVD mortality was assessed in 173,906 participants

Discussion

To our best knowledge, this is the first meta-analysis of pessimism, CVD events and mortality. We found 2 main findings. First, pessimism is associated with CVD events. Second, pessimism is associated with all-cause mortality.

Based on literature review, there are several proposed mechanisms that could explain the association between pessimism and mortality and CVD events. First, purely from a behavioral standpoint, pessimistic individuals differ in their coping strategies and health behaviors.10

Clinical significance

Though pessimism is to some extent “hard wired” via the mechanisms stated above, there is some potential to alter an individual patient's pessimism-optimism axis. For example, one study showed that an optimism-enhancing intervention increased the pursuit of engagement-related happiness in the short term and reduced dysfunctional attitudes in the longer term.60 Pessimistic individuals had more to gain and reported fewer depressive symptoms at post-test. Greater increases in mindfulness from

Funding source(s) related to this manuscript

None.

Author contributions

All authors had access to the data, contributed significantly to the work and a role in writing the manuscript.

Declaration of Competing Interest

Dr. Krittanawong discloses the following relationships – Member of the American College of Cardiology Solution Set Oversight Committee, the American Heart Association Committee of the Council on Genomic and Precision Medicine, the American College of Cardiology/American Heart Association (ACC/AHA) Joint Committee on Clinical Data Standards, and the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Performance Measures, The Lancet Digital Health (Advisory Board),

References (61)

  • A. O’Donovan

    Pessimism correlates with leukocyte telomere shortness and elevated interleukin-6 in post-menopausal women

    Brain Behav Immun

    (2009)
  • K. Curzytek

    The effects of pessimism on cell-mediated immunity in rats

    Prog Neuro-Psychopharmacol Biol Psychiatry

    (2018)
  • T. Koren

    Insular cortex neurons encode and retrieve specific immune responses

    Cell

    (2021)
  • R. Admon et al.

    Dysfunctional reward processing in depression

    Curr Opin Psychol

    (2015)
  • J.L. Hanson et al.

    Blunted ventral striatum development in adolescence reflects emotional neglect and predicts depressive symptoms

    Biol Psychiatry

    (2015)
  • U. Herwig

    Neural correlates of a “pessimistic” attitude when anticipating events of unknown emotional valence

    Neuroimage

    (2007)
  • J.L. Meadows

    Cardiovascular imaging of biology and emotion: considerations toward a new paradigm

    Circ Cardiovasc Imaging

    (2020)
  • L. Smeijers et al.

    Psychological distress and personality factors in takotsubo cardiomyopathy

    Neth Hear J

    (2016)
  • E.I. Cekirdekci et al.

    Level of anxiety and depression in cardiac syndrome X

    Med Princ Pract

    (2019)
  • Q.U.A. Jelani

    Relationship between depressive symptoms and health status in peripheral artery disease: role of sex differences

    J Am Heart Assoc

    (2020)
  • A. Rozanski

    association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis

    JAMA Netw Open

    (2019)
  • J.B. Whitfield

    Pessimism is associated with greater all-cause and cardiovascular mortality, but optimism is not protective

    Sci Rep

    (2020)
  • M.F. Scheier et al.

    Dispositional optimism and physical health: a long look back, a quick look forward

    Am Psychol

    (2018)
  • L.S. Nes et al.

    Dispositional optimism and coping: a Meta-analytic review

    Personal Soc Psychol Rev

    (2006)
  • M. Pänkäläinen

    Pessimism, diet, and the ability to improve dietary habits: a three-year follow-up study among middle-aged and older Finnish men and women

    Nutr J

    (2018)
  • C. Ramírez-Maestre et al.

    The role of optimism and pessimism in chronic pain patients adjustment

    Span J Psychol

    (2013)
  • J. Holt-Lunstad et al.

    Social relationships and mortality risk: a meta-analytic review

    PLoS Med

    (2010)
  • S. Cohen

    Psychosocial models of the role of social support in the etiology of physical disease

    Health Psychol

    (1988)
  • R. Böhm

    Are we looking for positivity or similarity in a partner's outlook on life? Similarity predicts perceptions of social attractiveness and relationship quality

    J Posit Psychol

    (2010)
  • M. Vollmann et al.

    Optimism and social support: the providers’ perspective

    J Posit Psychol

    (2007)

    • Cited by (0)

    View full text
    © 2022 Elsevier Inc. All rights reserved.