In an increasingly digital world, creating and maintaining meaningful, joyful connections have become more challenging. Beyond the short-term impact of loneliness and isolation on stress levels, mood and behavior, evidence suggests our psychological well-being affects cardiovascular health.

Optimism was linked to a 35% lower risk of incident cardiovascular disease events and a 14% lower risk of all-cause mortality in a large systematic review and meta-analysis.¹ A high sense of purpose in life was associated with a 17% reduction in both cardiovascular events and all-cause mortality in a large pooled analysis.² A positive affect was found related to a 22% decrease in 10-year incident coronary heart disease in a large population-based study.³ Higher levels of positive emotions were associated with better cardiovascular health scores over 20 years, although not with a slower rate of cardiovascular health decline, in the CARDIA study of young adults (55% women and 48% Black).⁴

Whether positive emotions beget better baseline cardiovascular health or whether excellent cardiovascular health also begets positive emotions remains unclear. The relationship is likely bidirectional via biomarkers and risk modulators that mediate atherothrombosis.⁵

Emotions Impact Vascular Endothelium

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Understanding the mechanisms driving these cardiovascular benefits can help to integrate pathophysiology with a holistic patient evaluation. Proposed mechanisms include improved health behaviors, such as choosing not to smoke and engaging in more physical activity, enhanced stress buffering capabilities and more favorable autonomic responses to stressful stimuli.

The vascular endothelium demonstrates sensitivity to negative emotions, both episodic and chronic. Impaired endothelium-dependent vasodilation in response to episodic anger has been shown,⁶ and repeated exposure could result in maladaptive responses. Wall motion abnormalities, stress cardiomyopathies due to catecholaminergic surges and changes in autonomic nervous system augmentation have been linked to natural disasters and major life stressors.^7-9

Chronic stress, including posttraumatic stress disorder, depression and anxiety, has been linked to increased sympathetic nervous system activity and concurrent attenuated vagal activity, increased levels of inflammation, development of endothelial dysfunction and increased arterial stiffness.^10-11

In contrast, studies of a positive affect have suggested a relationship with reduced cortisol output, lower resting heart rate and lower levels of inflammatory markers (e.g., C-reactive protein, IL-6, etc.).^12-14 These results indicate a potential to beneficially reduce cardiovascular disease risk through the promotion of psychosocial well-being.

Physiological and biochemical studies have focused on endothelial function given its role as the superhighway for oxygen and nutrient delivery. Mirthful laughter, compared to mentally stressful activities, was associated with improved endothelial-dependent flow-mediated dilation and brachial artery reactivity. This may be due to activation of mu3 opiate receptors, expressed in vascular endothelium, and subsequent upregulation of nitric oxide synthesis, improving vasodilation while reducing platelet aggregation and leukocyte migration.¹⁵

Slower progression of atherosclerosis has been associated with psychological well-being, perhaps
attributable to lower levels of inflammation, triglycerides, higher HDL-C and better glucose regulation.^16-18

Building Joy, Connections

Psychological, pharmacological and behavioral strategies designed to enhance well-being could help to reduce the risk of heart disease and improve overall health.¹⁹

Structured psychotherapy and stress management programs, such as group-based cognitive behavioral therapy, are effective in reducing symptoms of anxiety and depression.²⁰ These programs teach individuals to reframe negative thoughts, develop healthier coping mechanisms and build resilience.

Pharmacological interventions, such antidepressants, can safely and effectively reduce depressive symptoms, highlighting the value of routine screening and treating depression in cardiac patients.^21,22

Gratitude journaling, reflecting on positive experiences, and identifying and using personal strengths cultivate optimism and life satisfaction. These practices boost mood and lay a key foundation for adopting healthier behaviors, like improving dietary choices, medication adherence, not smoking, physical activity and sleep.^23-25

Mindfulness-based interventions like yoga, Tai Chi and meditation foster a more positive outlook by guiding individuals to reduce rumination and focus on the present. These practices reduce inflammation, lower blood pressure and promote good quality sleep.^26,27 Regular physical activity benefits the heart directly, boosts mood and reduces stress, contributing to joy and well-being.

Strengthening social connections with family, friends and community provides emotional support, and by reducing loneliness in turn it can reduce cardiac events.^28,29 Engaging in acts of kindness, volunteering and pursuing meaningful activities can lead to a sense of purpose, gratitude and belonging, thereby reducing cardiovascular risk.^30,31

Fostering joy, optimism and positive social connections is beneficial for mental health – and a powerful tool for preventing and managing cardiovascular disease. A holistic approach to well-being that integrates all these strategies provides protective benefits for overall heart health.³²

References

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3. Davidson KW, Mostofsky E, Whang W. Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey. Eur Heart J 201031(9):1065-70.
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Keywords: Cardiology Magazine, ACC Publications, Stress Disorders, Post-Traumatic, Loneliness, Depression, Vascular Stiffness, Emotions, Anxiety, Health Behavior