Maintaining positive thoughts and feelings through intervention programs may help patients achieve better overall cardiovascular health outcomes, according to a review paper published Sept. 10 in the Journal of the American College of Cardiology.

Darwin R. Labarthe, MD, MPH, et al., looked at a growing body of research to examine whether psychological well-being might lead to reduced risk of cardiovascular disease. They note that prospective studies have shown a positive relationship between optimism (one facet of psychological well-being) and cardiovascular disease, while additional studies have associated a perceived higher purpose in life with lower odds of having a stroke.

Researchers found that in the health behavior components (healthy diet, physical activity, smoking status and body mass index [BMI]), the most optimistic patients were less likely to be current smokers 12 months later, and high levels of psychological well-being were associated with regular physical activity. Optimistic patients sustained healthier diets by consuming more fruits and vegetables, and less processed meats and sweets, leading patients to maintain a healthy BMI. Psychological well-being influenced cardiovascular health through biological processes, health behaviors and psychosocial resources.

The review also found that having a strong network of social support gives patients confidence about their future health and helps them act readily on medical advice, engage in problem solving and take active preventive measures. A likely link is that favorable social environment, known to influence cardiovascular disease risk, has also been shown to predict psychological well-being. Additionally, intervention programs may strengthen psychological well-being. Mindfulness programs have been shown to improve anxiety, quality of life, smoking cessation, healthy eating and more. Yoga and tai chi, often incorporated in mindfulness-based interventions, have improved outcomes in heart failure patients and lowered blood pressure. Life purpose programs for palliative care patients have led to improvements in mental health, distress from physical symptoms and overall well-being.

“It may seem challenging to help patients modify psychological well-being in the face of a new medical diagnosis, but these events can represent a ‘teachable moment.’” Labarthe said. “Just having patient-centered discussions surrounding sources of psychological well-being and information about specific activities to promote well-being are a small, but meaningful, part of a patient’s care.”  

The authors conclude that “with wider experience and further evidence, clinical practice recommendations and health policy guidelines for psychological well-being interventions could substantially affect population-level [cardiovascular health].”

This paper is the fifth in an eight-part cardiovascular health promotion JACC focus seminar, where each paper focuses on a different behavioral consideration that impacts cardiovascular health: nutrition and diet; tobacco-free lifestyle; cholesterol; blood pressure; psychological health; healthy weight; exercise and physical activity and blood sugar.

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Keywords: Body Mass Index, Vegetables, Tobacco, Smoking Cessation, Blood Glucose, Mindfulness, Mental Health, Yoga, Fruit, Blood Pressure, Palliative Care, Palliative Care, Quality of Life, Body Weight, Diet, Health Behavior, Life Style, Health Promotion, Exercise, Smoking, Cholesterol, Social Support, Emotions, Anxiety, Social Environment, Cardiovascular Diseases, Health Policy, Heart Failure, Stroke, Problem Solving, Biological Phenomena, Meat

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