Heart Health When Life Is Satisfying: Evidence From The Whitehall II Cohort Study

Study Questions:

Does a positive state of satisfaction affect risk of coronary heart disease (CHD)?


The Whitehall II cohort comprises 10,308 British civil servants initially examined during 1985-1988. Phase 3 (1991-1994) serves as a baseline for the present study since domain satisfaction was measured at that time point. Participants who had experienced a cardiovascular event, died, or withdrawn prior to Phase 3 were excluded from the present analysis. Satisfaction was assessed with items asking: “All things considered, how satisfied or dissatisfied are you with the following areas of your life?” Participants evaluated eight areas including their “marital or love relationship,” “leisure time activities,” “standard of living,” “job,” “health,” “family life,” “sex life,” and feelings “about yourself as a person.” Data on CHD risk factors were also collected. Incident CHD (angina, nonfatal myocardial infarction, or death from CHD) was ascertained from medical screening, hospital data, and registry linkage over five person-years of follow up.


Data from 7,956 participants (5,496 men and 2,460 women; mean age 49.5 years) with no missing data on the primary exposures and outcomes were used for the present analysis. During an average of 5.42 person-years of follow-up, there were 293 cases of incident CHD. Satisfaction averaged across domains was associated with reduced CHD risk (hazard ratio, 0.87; 95% confidence interval, 0.78-0.98), controlling for demographic characteristics, health behaviors, blood pressure, and metabolic functioning. Associations with CHD risk were evident for satisfaction in four life domains including one’s job, family, sex life, and self, but not one’s love relationship, leisure activities, or standard of living. When examining CHD outcomes separately, average domain satisfaction was associated with angina, but not myocardial infarction or coronary death.


The investigators concluded that satisfaction in many life domains was associated with reduced CHD risk, and that satisfaction with life may promote heart health. Further research was suggested to determine if interventions to enhance life satisfaction in specific domains would result in reduced CHD risk.


These interesting findings suggest that wellness is a continuum of balance and that clinicians may wish to discuss the balance of life with patients, including characteristics of satisfaction, in addition to measuring physiologic parameters such as lipids or blood pressure.

Keywords: Myocardial Infarction, Love, Follow-Up Studies, Marriage, Personal Satisfaction, Coronary Disease, Risk Factors, Blood Pressure, Health Behavior

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